OBJECTIVE: To evaluate the efficacy and safety of Shexiang Tongxin Dropping Pill (STDP) in treating stable angina patients with phlegm-heat and blood-stasis syndrome by exercise duration and metabolic equivalents. METHODS: This multicenter, randomized, double-blind, placebo-controlled clinical trial enrolled stable angina patients with phlegm-heat and blood-stasis syndrome from 22 hospitals. They were randomized 1:1 to STDP (35 mg/pill, 6 pills per day) or placebo for 56 days. The primary outcome was the exercise duration and metabolic equivalents (METs) assessed by the standard Bruce exercise treadmill test after 56 days of treatment. The secondary outcomes included the total angina symptom score, Chinese medicine (CM) symptom scores, Seattle Angina Questionnaire (SAQ) scores, changes in ST-T on electrocardiogram and adverse events (AEs). RESULTS: This trial enrolled 309 patients, including 155 and 154 in the STDP and placebo groups, respectively. STDP significantly prolonged exercise duration with an increase of 51.0 s, compared to a decrease of 12.0 s with placebo (change rate: -11.1% vs. 3.2%, P<0.01). The increase in METs was significantly greater in the STDP group than in the placebo group (change: -0.4 vs. 0.0, change rate: -5.0% vs. 0.0%, P<0.01). The improvement of total angina symptom scores (25.0% vs. 0.0%), CM symptom scores (38.7% vs. 11.8%), reduction of nitroglycerin consumption (100.0% vs. 11.3%), and all domains of SAQ, were significantly greater with STDP than placebo (all P<0.01). The changes in Q-T intervals at 28 and 56 days from baseline were similar between the two groups (both P>0.05). Twenty-five participants (16.3%) with STDP and 16 (10.5%) with placebo experienced AEs (P=0.131), with no serious AEs observed. CONCLUSION STDP could improve exercise tolerance in patients with stable angina and phlegm-heat and blood stasis syndrome, with a favorable safety profile. (Registration No. ChiCTR-IPR-15006020).
Humans ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Middle Aged ; Angina, Stable/physiopathology* ; Aged ; Syndrome ; Treatment Outcome ; Placebos ; Tablets

Thoracic aortic aneurysm (TAA) significantly endangers the lives of individuals with Marfan syndrome (MFS), yet the intricacies of their biomechanical origins remain elusive. Our investigation delves into the pivotal role of hemodynamic disturbance in the pathogenesis of TAA, with a particular emphasis on the mechanistic contributions of the mammalian target of rapamycin (mTOR) signaling cascade. We uncovered that activation of the mTOR complex 1 (mTORC1) within smooth muscle cells, instigated by the oscillatory wall shear stress (OSS) that stems from disturbed flow (DF), is a catalyst for TAA progression. This revelation was corroborated through both an MFS mouse model (Fbn1 ^+/C1039G) and clinical MFS specimens. Crucially, our research demonstrates a direct linkage between the activation of the mTORC1 pathway and the intensity in OSS. Therapeutic administration of rapamycin suppresses mTORC1 activity, leading to the attenuation of aberrant SMC behavior, reduced inflammatory infiltration, and restoration of extracellular matrix integrity-collectively decelerating TAA advancement in our mouse model. These insights posit the mTORC1 axis as a strategic target for intervention, offering a novel approach to manage TAAs in MFS and potentially pave insights for current treatment paradigms.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Thoracic aortic aneurysm(TAA)significantly endangers the lives of individuals with Marfan syndrome(MFS),yet the intricacies of their biomechanical origins remain elusive.Our investigation delves into the pivotal role of hemodynamic disturbance in the pathogenesis of TAA,with a particular emphasis on the mechanistic contributions of the mammalian target of rapamycin(mTOR)signaling cascade.We un-covered that activation of the mTOR complex 1(mTORC1)within smooth muscle cells,instigated by the oscillatory wall shear stress(OSS)that stems from disturbed flow(DF),is a catalyst for TAA progression.This revelation was corroborated through both an MFS mouse model(Fbn1+/C1039G)and clinical MFS specimens.Crucially,our research demonstrates a direct linkage between the activation of the mTORC1 pathway and the intensity in OSS.Therapeutic administration of rapamycin suppresses mTORC1 activity,leading to the attenuation of aberrant SMC behavior,reduced inflammatory infiltration,and restoration of extracellular matrix integrity—collectively decelerating TAA advancement in our mouse model.These insights posit the mTORC1 axis as a strategic target for intervention,offering a novel approach to manage TAAs in MFS and potentially pave insights for current treatment paradigms.

Objective:To examine the relationships between perceived organizational support in job resources, self-efficacy in personal resources, and teaching commitment based on the job requirement-resource model, and to explore the path of influencing clinical teachers' teaching commitment.Methods:Using the convenience sampling method, 463 clinical teachers from 16 university-affilicated hospitals in Shandong Province, China were selected as the study subjects. Surveys were conducted using the Perceived Organizational Support Scale, Self-efficacy Scale, and Teaching Commitment Scale. A statistical analysis was performed using SPSS 26.0. A structural equation model was constructed using AMOS 26.0 to test the mediation effect.Results:①The level of teaching commitment of clinical teachers was relatively high, with a total score of (45.25±9.21) points. The total score of perceived organizational support was (38.22±9.75) points, and the total score of self-efficacy was (112.27±17.30) points. ②Perceived organizational support and self-efficacy were positively correlated with teaching commitment ( r=0.59, r=0.65, both P<0.01). ③ Perceived organizational support had significant and direct positive effects on teaching commitment and self-efficacy ( β=0.36, β=0.51, both P<0.01). Self-efficacy significantly and positively affected teaching commitment ( β=0.47, P<0.01). Self-efficacy played a significant and partial mediating role in the effect of perceived organizational support on teaching commitment (standardized mediating effect value of 0.239, P<0.01), and the mediating effect percentage was 39.83%. Conclusions:Perceived organizational support not only directly predicts clinical teachers' teaching commitment, but also indirectly affects teaching commitment through self-efficacy. University-affiliated hospital administrators should pay attention to clinical teachers' perceived organizational support to improve their self-efficacy and teaching commitment, thereby ensuring teaching quality.

Objective To explore the influencing factors of acute kidney injury in severe burn patients,and to construct a visual risk nomogram model.Methods A total of 390 patients with severe burn admitted to the Institute of Burn Frostbite and Tissue Function Reconstruction of Chinese People's Armed Police Force Specialty Medical Center from January 2018 to January 2022 were collected as an internal training data set,and 50 patients with severe burn admitted from February to December 2022 were collected as an external validation data set.The 390 patients of the internal training data set were divided into the acute kidney injury group and the non-acute kidney injury group according to the occurrence of acute kidney injury,and the baseline data of patients in the two groups were compared.Univariate and multivariate Logistic regression were used to analyze the risk factors of acute kidney injury in severe burn patients of the internal training data set,and a nomogram model was drawn.Subsequently,the model was verified both internally and externally.Kaplan-Meier analysis and Log-rank test were used to compare the 90-day survival rate of patients between the acute kidney injury group and the non-acute kidney injury group.Results The burn area(OR=1.18,95%CI:1.06 to 2.36,P=0.004),sequential organ failure assessment(SOFA)score(OR=1.81,95%CI:1.21 to 5.92,P<0.001),inhalation injury(OR=3.21,95%CI:1.23 to 6.35,P<0.001),neutrophil to lymphocyte ratio(NLR)(OR=1.22,95%CI:1.05 to 3.65,P<0.001)and albumin(ALB)(OR=0.78,95%CI:0.57 to 0.92,P=0.011)were the independent risk factors for the development of acute kidney injury in severe burn patients.The nomogram model was established by the above factors.The area under the receiver operating characteristic curve(AUC)of the internal training data set was 0.833(95%CI:0.752 to 0.935),the sensitivity was 81.2%,and the specificity was 83.2%.The AUC of the external validation data set was 0.842(95%CI:0.762 to 0.912),the sensitivity 87.2%,and the specificity was 78.7%.The 90-day survival rate of patients in the acute kidney injury group after burns was significantly lower than that in the non-acute kidney injury group(P<0.001).Conclusion Larger burn area,higher SOFA score,combined inhalation injury,increased NLR,and decreased ALB level are the risk factors for the occurrence of acute kidney injury in severe burn patients,which are related to the 90-day survival rate of patients after burns.The nomogram model based on the risk factors can provide certain reference for clinical individualized prevention and treatment of acute kidney injury in severe burn patients.

Objective:To explore the applicability and effectiveness of the "Hand as Foot" visual teaching method in bedside teaching of spinal surgical diseases, investigate its impact on enhancing student learning outcomes and clinical application abilities, and provide new directions and guidance for teaching methods.Methods:A total of 60 students from the five-year clinical medicine program enrolled in 2019 at Inner Mongolia Medical University were selected and randomly assigned to either an experimental group or a control group (30 students each) using a random number table. The teaching content covered bedside knowledge related to spinal surgery. The control group received traditional oral bedside teaching method, while the experimental group received the "Hand as Foot" visual teaching method. Both groups of students received eight 45-min bedside teaching sessions. After class, teaching effectiveness was evaluated through a theoretical knowledge examination and student classroom satisfaction was evaluated, including interest in learning, enthusiasm and participation, classroom activity, teacher-student interaction, and mastery of theoretical knowledge. SPSS 27.0 software was used for statistical analysis. Continuous variables were expressed as mean ± standard deviation and compared using the t-test; categorical variables were presented as numbers or percentages and compared using the chi-square test. Results:The experimental group scored (78.80±3.19) on the theoretical knowledge examination, while the control group scored (73.20±4.89), with a significant difference between the two groups ( t=3.72, P=0.001). In the classroom satisfaction survey, the experimental group also outperformed the control group in learning interest [(9.60±0.51) vs. (8.40±0.74)], enthusiasm and participation [(9.40±0.63) vs. (8.07±0.70)], classroom activity [(9.53±0.64) vs. (8.67±0.81)], teacher-student interaction [(9.53±0.52) vs. (8.33±0.72)], and mastery of theoretical knowledge [(8.60±0.91) vs. (7.20±0.77)], with all differences being statistically significant ( P<0.05). Conclusions:The "Hand as Foot" visual teaching method is suitable for bedside teaching of spinal diseases, allowing students to understand diseases more vividly. This method not only facilitates effective communication between teachers and students, enhances student understanding of relevant knowledge, and improves their confidence in learning, but also inspires a more proactive learning attitude.

Objective To explore the influencing factors of acute kidney injury in severe burn patients,and to construct a visual risk nomogram model.Methods A total of 390 patients with severe burn admitted to the Institute of Burn Frostbite and Tissue Function Reconstruction of Chinese People's Armed Police Force Specialty Medical Center from January 2018 to January 2022 were collected as an internal training data set,and 50 patients with severe burn admitted from February to December 2022 were collected as an external validation data set.The 390 patients of the internal training data set were divided into the acute kidney injury group and the non-acute kidney injury group according to the occurrence of acute kidney injury,and the baseline data of patients in the two groups were compared.Univariate and multivariate Logistic regression were used to analyze the risk factors of acute kidney injury in severe burn patients of the internal training data set,and a nomogram model was drawn.Subsequently,the model was verified both internally and externally.Kaplan-Meier analysis and Log-rank test were used to compare the 90-day survival rate of patients between the acute kidney injury group and the non-acute kidney injury group.Results The burn area(OR=1.18,95%CI:1.06 to 2.36,P=0.004),sequential organ failure assessment(SOFA)score(OR=1.81,95%CI:1.21 to 5.92,P<0.001),inhalation injury(OR=3.21,95%CI:1.23 to 6.35,P<0.001),neutrophil to lymphocyte ratio(NLR)(OR=1.22,95%CI:1.05 to 3.65,P<0.001)and albumin(ALB)(OR=0.78,95%CI:0.57 to 0.92,P=0.011)were the independent risk factors for the development of acute kidney injury in severe burn patients.The nomogram model was established by the above factors.The area under the receiver operating characteristic curve(AUC)of the internal training data set was 0.833(95%CI:0.752 to 0.935),the sensitivity was 81.2%,and the specificity was 83.2%.The AUC of the external validation data set was 0.842(95%CI:0.762 to 0.912),the sensitivity 87.2%,and the specificity was 78.7%.The 90-day survival rate of patients in the acute kidney injury group after burns was significantly lower than that in the non-acute kidney injury group(P<0.001).Conclusion Larger burn area,higher SOFA score,combined inhalation injury,increased NLR,and decreased ALB level are the risk factors for the occurrence of acute kidney injury in severe burn patients,which are related to the 90-day survival rate of patients after burns.The nomogram model based on the risk factors can provide certain reference for clinical individualized prevention and treatment of acute kidney injury in severe burn patients.

Objective:To examine the relationships between perceived organizational support in job resources, self-efficacy in personal resources, and teaching commitment based on the job requirement-resource model, and to explore the path of influencing clinical teachers' teaching commitment.Methods:Using the convenience sampling method, 463 clinical teachers from 16 university-affilicated hospitals in Shandong Province, China were selected as the study subjects. Surveys were conducted using the Perceived Organizational Support Scale, Self-efficacy Scale, and Teaching Commitment Scale. A statistical analysis was performed using SPSS 26.0. A structural equation model was constructed using AMOS 26.0 to test the mediation effect.Results:①The level of teaching commitment of clinical teachers was relatively high, with a total score of (45.25±9.21) points. The total score of perceived organizational support was (38.22±9.75) points, and the total score of self-efficacy was (112.27±17.30) points. ②Perceived organizational support and self-efficacy were positively correlated with teaching commitment ( r=0.59, r=0.65, both P<0.01). ③ Perceived organizational support had significant and direct positive effects on teaching commitment and self-efficacy ( β=0.36, β=0.51, both P<0.01). Self-efficacy significantly and positively affected teaching commitment ( β=0.47, P<0.01). Self-efficacy played a significant and partial mediating role in the effect of perceived organizational support on teaching commitment (standardized mediating effect value of 0.239, P<0.01), and the mediating effect percentage was 39.83%. Conclusions:Perceived organizational support not only directly predicts clinical teachers' teaching commitment, but also indirectly affects teaching commitment through self-efficacy. University-affiliated hospital administrators should pay attention to clinical teachers' perceived organizational support to improve their self-efficacy and teaching commitment, thereby ensuring teaching quality.