Aim To investigate the potential role and related mechanisms of protein phosphatase 2Cm(PP2Cm)overexpression in atorvastatin-induced insu-lin resistance.Methods Male C57BL/6J mice,fibro-blast growth factor 21 knockout(FGF21-KO)mice,and wildtype(WT)mice were raised for 12 weeks to construct models.Groups included atorvastatin,con-trol,atorvastatin+PP2Cm overexpression(OE),FGF21-KO+vehicle,FGF21-KO+PP2Cm OE,WT+vehicle,WT+PP2Cm OE.Body weight,fasting blood glucose levels,fasting insulin levels,and intraperitoneal glucose tolerance tests(IPGTT)were measured in 4,8 and 12 weeks.The concentrations of branched-chain a-mino acids(BCAA)in cells,tissues and serum,as well as the mRNA and protein expression of BCAA cat-abolic enzymes,were determined by qRT-PCR,Western blot and ELISA after atorvastatin treatment.Further-more,the effects of PP2Cm overexpression on these in-dicators were explored,and the FGF21 was verified in vivo and in vitro.Results Atorvastatin induced insu-lin resistance in mice,altered insulin,glucose tolerance and increased BCAA levels.PP2Cm overexpression mitigated these changes.In the Atorvastatin+PP2Cm OE group,FGF21 mRNA,protein and concentration were all significantly upregulated.Regardless of PP2Cm overexpression,the knockout of FGF21 signifi-cantly increased BCAA expression levels,both fasting insulin and blood glucose levels were significantly high-er than those in WT group.Conclusions FGF21 may be an important regulator of PP2Cm involved in atorv-astatin-induced insulin resistance.PP2Cm overexpres-sion alleviates the effects of atorvastatin-induced insulin resistance by regulating FGF21.

Objective:To investigate the current status and challenges of pediatric life support training in China and provide references for improving training quality.Methods:A cross-sectional study was conducted to collect data from pediatric life support training centers across the country，covering basic institutional information，training capacity and training faculty，training program funding，as well as existing challenges and issues.The domestic registry of training centers in 2023 was obtained through the American Heart Association's online platform.After contacting and verifying each center，an online questionnaire was distributed，and the aggregated data were statistically analyzed.Results:A total of 42 institutions participated in the survey，including 19 children's hospitals，14 general hospitals，6 maternal and child health hospitals，2 women and children’s hospitals，and 1 training institution.The distribution of training centers showed a concentration in coastal areas，with the top three provinces/municipalities being Guangdong（7/42，16.7%），Zhejiang（6/42，14.3%），and Shanghai（4/42，9.5%）.As of December 31 2023，the 42 institutions had an annual basic life support（BLS）training volume of 8 587 individuals，the median was 120 (100,200)，and an annual pediatric advanced life support（PALS）training volume of 2 448 individuals，the median was 30 (20,50).Among the 42 institutions，there were 598 BLS instructors and 306 PALS instructors.Among the surveyed institutions，24（24/42，57.1%）reported BLS instructor teams comprising fewer than 10 members，and 33（33/42，78.6%）reported PALS instructor teams comprising fewer than 10.Only 7 centers(7/42,16.7%）reported having dedicated funding support.The top three challenges were：training sessions occupying instructors’personal time（27/42，64.3%），low instructor compensation（16/42，38.1%），and issues with the data submission system（16/42，38.1%）.Conclusion:Pediatric life support training centers in China are primarily children’s hospitals，with a geographical concentration in coastal areas，which is also reflected in the distribution of training scale and instructor resources.Most centers have relatively small training scales and limited instructor capacity，with many instructors conducting training during their personal time.These issues may hinder the implementation and effectiveness of training programs.

Objective:To evaluate the clinical efficacy of inferior gluteus maximus muscle-pedicled myocutaneous flap for reconstruction of stage Ⅳ ischial pressure sores.Methods:Clinical data of patients with stage Ⅳ ischial pressure sores treated between April 2020 and September 2023 at the First People’s Hospital of Yulin were retrospectively analyzed. Underlying comorbidities were treated preoperatively to assure surgical safety. Stage Ⅰ management involved radical debridement of infected tissue followed by vacuum sealing drainage (VSD). Stage Ⅱ reconstruction was performed after inflammation control. An inferior gluteus maximus-pedicled myocutaneous flap was designed laterally to the defect. The muscle component width exceeded the skin paddle width, with the distal muscle extending about 3 cm beyond the skin island. The flap was advanced medially in a V-Y fashion to cover the defect. The donor site was sutured in layers. Postoperative flap viability, wound healing, aesthetic outcomes, and pressure sores recurrence were assessed.Results:A total of 20 patients were included in this study. Among them, 14 were males and 6 were females. The age ranged from 27 to 72 years, with a mean age of 52.3 years. The body mass index (BMI) ranged from 17.8 to 31.3 kg/m 2, with a mean BMI of 21.0 kg/m 2. All had paraplegia secondary to spinal cord injury. Comorbidities included type 2 diabetes and (or) hypertension (10 cases) and ischial osteomyelitis (3 cases). Pressure sores duration ranged from 1 month to 3 years. Defect sizes were 3 cm×4 cm to 5 cm×10 cm (depth: 3-6 cm). Flap sizes matched defects (3 cm×4 cm to 5 cm×10 cm), with muscle dimensions of 2 cm×5 cm×9 cm to 3 cm×8 cm×15 cm. Postoperatively, all 20 flaps showed good blood supply without flap necrosis. The wound healing time ranged from 12 to 22 days (mean: 15 days). Seventeen cases achieved primary wound healing. The remaining three cases developed fat liquefaction at the donor sites, but their wounds eventually healed after dressing changes on postoperative days 18, 20, and 22, respectively. During follow-up (mean: 13 months, range: 6-34 months), the flaps maintained good texture with no recurrence. Conclusion:The inferior gluteus maximus muscle-pedicled myocutaneous flap provides sufficient bulk, simple design, and reliable transposition for dead-space obliteration and surface coverage in stage Ⅳ ischial pressure sores. This technique yields favorable aesthetics and low recurrence rates.

Objective To explore the application effect of hospital-community-home remote pulmonary rehabilita-tion management in patients with chronic obstructive pulmonary disease(COPD)and to provide references for clinical nursing practice.Methods The convenience sampling method was adopted to select patients from October 2023 to March 2024.Totally 86 COPD patients admitted to the respiratory department of a tertiary hospital in Nanjing were randomly divided into an experimental group(n=43)and a control group(n=43).The experimental group received the hospital-community-family triadic closed-loop remote pulmonary rehabilitation care,while the control group received only conventional home-based pulmonary rehabilitation care,and the duration of intervention is 3 months.The dif-ferences in adherence to pulmonary rehabilitation training,exercise endurance,degree of dyspnea,quality of life,and lung function were compared between the 2 groups after intervention.Results The experimental group and control group each included 42 cases and 40 cases finally.After intervention,the experimental group showed better out-comes than the control group in adherence to pulmonary rehabilitation training,exercise endurance,degree of dysp-nea,quality of life with statistically significant differences(P＜0.05).There were no statistically significant differences between the 2 groups in lung function(P＞0.05).Conclusion The hospital-community-family remote pulmonary re-habilitation management can improve COPD patients'adherence to pulmonary rehabilitation training,exercise en-durance,reduce patient's dyspnea symptoms and improve quality of life.

This review has introduced the Coronary Artery Tree description and Lesion EvaluaTion(CatLet or Hexu)angiographic scoring system,which,based solely on coronary angiography results,has characterized 6 types of right coronary artery,3 types of left descending artery,and 3 types of diagonal size,together resulting in 54 types of coronary circulation pattern.This novel angiographic scoring system can be utilized to account for coronary anatomy in its diversity,severity and complexity of diseased coronary arteries,and their subtended myocardial territories in jeopardy.The CatLet angiographic scoring system is unique in that the importance of a coronary artery is weighted according to its subtended myocardial segments,by which the variability of coronary artery has been accounted for and measured.Researchers at home and abroad have increasingly paid attention to its clinical utilities,which warrant further validation in the context of large sample size,prospective,and randomized controlled trials.The CatLet angiographic scoring system is accessible at www.catletscore.com.

With the accelerating global aging process,falls among older adults have emerged as a significant health problem,which not only significantly impacts their quality of life,but also brings a heavy social burden.Cognition-motor dual-task training,an important intervention for preventing falls,can significantly enhance the cognitive and motor functions in older adults.This article reviewed the implementation forms,mechanism and application effects.It aims to provide references for the implementation of cognition-motor dual-task training in older adults.

Objective To explore the acupoint selection law and staged acupuncture prescriptions in the treatment of post-stroke dysphagia using data mining technology.Methods Clinical research literature about acupuncture treatment of post-stroke dysphagia was retrieved from CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,Cochrane Library from January 1,2004 to October 1,2024.Prescription information was organized and summarized,and was entered into the database.Descriptive analysis,association rule analysis,complex network analysis and clustering analysis on prescription acupoints were conducted with Excel 2021,SPSS Modeler 18.0 and SPSS 26.0 softwares.Results A total of 306 articles were included,including 328 acupuncture prescriptions involving 118 acupoints,with a cumulative frequency of 1 541 times.The core acupoints were Lianquan,Fengchi,Yuye,Jinjin,Yifeng,Jialianquan,Fengfu and Wangu.The main meridians were Conception Vessel,gallbladder meridian,Governor Vessel and stomach meridian.The distribution was concentrated in the head,face and neck,and the use of intersection acupoints were the most.Association rule analysis showed that Lianquan-Fengchi,Lianquan-Jinjin-Yuye had the highest degree of support for association rules,and the clustering analysis showed 4 categories such as Jialianquan-Baihui-Fengfu.The analysis obtained corresponding acupuncture prescriptions for oral stage,pharyngeal stage and esophageal stage of dysphagia.Conclusion Acupuncture treatment of post-stroke dysphagia is mainly based on local acupoint and acupoint along meridians,mostly using intersection acupoints,combined with distal acupoints,and selecting the corresponding acupoints in different periods,which can improve the clinical efficacy.

Objective To evaluate the prognostic nutritional index(PNI)in patients with newly diagnosed type 2 diabetes mellites(T2DM)complicated with diabetic peripheral neuropathy(DPN).Methods A total of 300 patients with newly diagnosed T2DM from the Wenzhou People's Hospital during January 2017 to March 2023 were enrolled in this study.The patients were divided into uncomplicated DPN(n=214)and complicated DPN(n=86).The general data,biochemical indicators,PNI and other clinical indicators of the two groups were compared.According to PNI thirds,patients were divided into three groups:low,medium and high,comparing the proportion of DPN among the three groups;Logistic regression calculated the risk of DPN in different groups;Drawing receiver operating characteristic curve to analyze PNI and other indicators to predict the value of DPN.Results Compared with the non-DPN group,patients had lower PNI in the DPN group(P＜0.05);lower PNI was associated with higher risk of DPN(P＜0.001).Area under the curve of PNI was 0.882(95％CI:0.841-0.923,P＜0.001),and better predictive value of PNI for DPN than the systemic immune inflammation index,the neutrophil/lymphocyte ratio.Conclusion PNI is closely associated with the occurrence of DPN in newly diagnosed T2DM complicated,and PNI may be used as an important indicator for screening patients with T2DM complicated with DPN.

AIM To explore the clinical effects of Jinfukang Oral Liquid combined with thymosin α1 on patients with non-small cell lung cancer due to Dual Deficiency of Qi and Yin.METHODS Seventy-five patients were randomly assigned into thymosin α1 group(15 cases)for 4-week administration,Jinfukang Oral Liquid group(30 cases)for 4-week administration,and combination group(30 cases)for 4-week administration.The changes in TCM clinical syndrome effects,immunity indices(CD3+T,Th,CTL,total NK,CD56dim CD16+NK,NKT,Treg,MDSC),lethality/inhibition ratios(CTL/Treg,total NK/Treg,NKT/Treg,CTL/MDSC,total NK/MDSC,NKT/MDSC)and FACT-L scores were detected.RESULTS The Jinfukang Oral Liquid group and combination group demonstrated higher total effective rates than the thymosin α1 group(P＜0.05).After the treatment,the Jinfukang Oral Liquid group and combination group displayed increased NKT(P＜0.05)and decreased MDSC(P＜0.05),which were more obvious than those in the thymosin α1 group(P＜0.05),and higher NKT was observable in the Jinfukang Oral Liquid group(P＜0.05);the Jinfukang Oral Liquid group and combination group displayed increased lethality/inhibition ratios(P＜0.05),among which NKT/Treg,CTL/MDSC,total NK/MDSC,NKT/MDSC were higher than those in the thymosin α1 group(P＜0.05),and higher CTL/MDSC,NKT/MDSC were observable in the Jinfukang Oral Liquid group(P＜0.05);the Jinfukang Oral Liquid group(except for physiological status,society and family status)and combination group(except for society and family status)displayed increased FACT-L scores(P＜0.05).CONCLUSION For the patients with non-small cell lung cancer due to Dual Deficiency of Qi and Yin,Jinfukang Oral Liquid single use or combined with thymosin α1 can enhance peripheral blood immune surveillance,inhibit immune escape,restore the balanced state of tumor immune responses,and improve TCM syndromes and life quality.

Aim To investigate the potential role and related mechanisms of protein phosphatase 2Cm(PP2Cm)overexpression in atorvastatin-induced insu-lin resistance.Methods Male C57BL/6J mice,fibro-blast growth factor 21 knockout(FGF21-KO)mice,and wildtype(WT)mice were raised for 12 weeks to construct models.Groups included atorvastatin,con-trol,atorvastatin+PP2Cm overexpression(OE),FGF21-KO+vehicle,FGF21-KO+PP2Cm OE,WT+vehicle,WT+PP2Cm OE.Body weight,fasting blood glucose levels,fasting insulin levels,and intraperitoneal glucose tolerance tests(IPGTT)were measured in 4,8 and 12 weeks.The concentrations of branched-chain a-mino acids(BCAA)in cells,tissues and serum,as well as the mRNA and protein expression of BCAA cat-abolic enzymes,were determined by qRT-PCR,Western blot and ELISA after atorvastatin treatment.Further-more,the effects of PP2Cm overexpression on these in-dicators were explored,and the FGF21 was verified in vivo and in vitro.Results Atorvastatin induced insu-lin resistance in mice,altered insulin,glucose tolerance and increased BCAA levels.PP2Cm overexpression mitigated these changes.In the Atorvastatin+PP2Cm OE group,FGF21 mRNA,protein and concentration were all significantly upregulated.Regardless of PP2Cm overexpression,the knockout of FGF21 signifi-cantly increased BCAA expression levels,both fasting insulin and blood glucose levels were significantly high-er than those in WT group.Conclusions FGF21 may be an important regulator of PP2Cm involved in atorv-astatin-induced insulin resistance.PP2Cm overexpres-sion alleviates the effects of atorvastatin-induced insulin resistance by regulating FGF21.