BACKGROUND:Emodin has a variety of pharmacological activities such as anti-inflammatory,anti-viral and anti-oxidative stress,and also has a certain protective effect on sepsis-induced myocardial injury,but its mechanism of action is still unclear.OBJECTIVE:To investigate whether emodin can improve myocardial injury in septic mice by promoting autophagy.METHODS:Thirty-two male Kunming mice were divided into sham operation group(n=4),sham operation+emodin group(n=4),model group(n=8),model+emodin group(n=8),and emodin+3-methyladenine group(n=8).The myocardial injury model of septic mice was constructed by cecal ligation and puncture.3-methyladenine(10 mg/kg)was injected intraperitoneally 1 hour before modeling.Emodin(20 mg/kg)was injected intraperitoneally 30 minutes before modeling,and the other groups were injected with the same amount of normal saline at the same time point.Blood and myocardial samples were collected from all mice 24 hours after surgery.ELISA was used to detect the levels of brain natriuretic peptide and cardiac troponin Ⅰ in serum.Western blot assay was used to detect the protein expression of LC3B,Beclin-1,and p62 in myocardial tissue.Hematoxylin-eosin staining was used to observe the pathological changes in myocardial tissue.Ultrasound was used to evaluate the cardiac function of mice.RESULTS AND CONCLUSION:(1)Compared with the sham operation group,there was no significant difference in the levels of serum brain natriuretic peptide,cardiac troponin Ⅰ,and the protein expression of myocardial autophagy proteins LC3Ⅱ/LC3Ⅰ and p62 in the sham operation+emodin group(P＞0.05).(2)Compared with the sham operation+emodin group,the levels of serum brain natriuretic peptide and cardiac troponin I were significantly increased in the model group(P＜0.05).Compared with the model group,the levels of serum brain natriuretic peptide and cardiac troponin I were decreased in the model+emodin group(P＜0.05).(3)Compared with the model group,the expression of LC3Ⅱ/LC3Ⅰ and Beclin-1 protein was increased and the expression of p62 protein was decreased in the myocardial tissue of the model+emodin group(P＜0.05).Compared with the model+emodin group,the expression of LC3Ⅱ/LC3Ⅰ and Beclin-1 protein decreased and the expression of p62 protein increased in the emodin+3-methyladenine group(P＜0.05).(4)The myocardial fibers in the sham operation group were normal,the myocardial fibers in the model group were disordered with a large number of inflammatory cell infiltration,the myocardial fibers in the model+emodin group were slightly disordered,and some vacuolar changes were observed.The myocardial fibers were disordered,and more inflammatory cell infiltration was observed in the emodin+3-methyladenine group.(5)Compared with the sham operation group,the left ventricular short axis shortening rate and left ventricular ejection fraction were decreased in the model group(P＜0.05).Compared with the model group,the left ventricular short axis shortening rate and left ventricular ejection fraction were increased in the model+emodin group(P＜0.05).Compared with the model+emodin group,the left ventricular ejection fraction of emodin+3-methyladenine group was decreased(P＜0.05),and the left ventricular short axis shortening rate was reduced but not statistically significant(P＞0.05).(6)The above results indicate that emodin pretreatment can improve myocardial injury and myocardial dysfunction in septic mice by promoting autophagy.

Aim To investigate the effect of interdialytic serum potassium levels on thrombosis of autologous ar-teriovenous fistula(AVF)in patients with chronic kidney disease(CKD)on maintenance haemodialysis(MHD).Methods 159 CKD patients who underwent MHD in our hospital from October 2021 to October 2022 were retrospectively analyzed.They were divided into hyperkalemia group(n=53),normal serum potassium group(n=61)and hypokalemia group(n=45)according to the mean serum potassium level of patients with different dialysis intervals,and all patients were followed up for 1 year or followed up until AVF thrombosis.General datas were collected and the following indicators were detected at the time of patient enrolment,including biochemical indicators,inflammatory factors,ultrasound indicators of AVF and oxidative stress factors levels.Multifactorial Logistic regression equations were used to analyze the effects of clinical indicators on AVF thrombosis in MHD patients,receiver operating characteristic(ROC)curve was used to assess the predictive efficacy of clinical indicators on AVF thrombosis;And interval likelihood ratio was used to stratify interdialyt-ic serum potassium levels,and further observe whether the relationship was stability between AVF thrombosis and interdia-lytic serum potassium levels in MHD patients.Results Compared with the normal serum potassium group,the levels of C-reactive protein(CRP),intact parathyroid hormone(iPTH),procalcitonin(PCT),triglyceride(TG),malondial-dehyde(MDA),myeloperoxidase(MPO),brachial artery resistance index(RI),brachial artery pulsatility index(PI)and radial artery PI were significantly elevated in hyperkalemia group and hypokalemia group,while the levels of albumin(Alb),total cholesterol(TC),superoxide dismutase(SOD)and fistula blood flow were significantly reduced(P＜0.05).Systolic blood pressure,diastolic blood pressure,fistula blood flow,Alb and SOD levels were significantly lower in patients with AVF thrombosis than those in patients with AVF unthrombosis(P＜0.05);Interdialytic mean serum potassium level,CRP,iPTH,PCT,brachial artery RI,brachial artery PI,radial artery PI,radial artery RI,MDA and MPO levels were significantly higher in patients with AVF thrombosis(P＜0.05).The ROC curve was used to analyse the model estab-lished by the multifactorial Logistic regression equation,and it was found that model 1 and model 2 had good predictive effi-cacy,and model 2 had the best predictive efficacy.The results of the interval likelihood ratio showed that:when the patient's interdialytic serum potassium level was 3.5～4.5 mmol/L,the possibility of the patient's AVF thrombosis was the lowest,and when the patient's interdialytic serum potassium level was＞5.5 mmol/L or＜3.5 mmol/L,the possibility of the patient's AVF thrombosis was higher,and when the patient's serum potassium level was＞5.5 mmol/L,the probability of AVF thrombosis was the highest in patients,which was 3.925 times higher than that of patients without AVF thrombosis.Conclusion Abnormal interdialytic serum potassium levels may induce AVF thrombosis in CKD patients.Serum potassium levels can be monitored during MHD treatment to enable timely intervention and improve clinical treatment outcomes for patients.

BACKGROUND:Emodin has a variety of pharmacological activities such as anti-inflammatory,anti-viral and anti-oxidative stress,and also has a certain protective effect on sepsis-induced myocardial injury,but its mechanism of action is still unclear.OBJECTIVE:To investigate whether emodin can improve myocardial injury in septic mice by promoting autophagy.METHODS:Thirty-two male Kunming mice were divided into sham operation group(n=4),sham operation+emodin group(n=4),model group(n=8),model+emodin group(n=8),and emodin+3-methyladenine group(n=8).The myocardial injury model of septic mice was constructed by cecal ligation and puncture.3-methyladenine(10 mg/kg)was injected intraperitoneally 1 hour before modeling.Emodin(20 mg/kg)was injected intraperitoneally 30 minutes before modeling,and the other groups were injected with the same amount of normal saline at the same time point.Blood and myocardial samples were collected from all mice 24 hours after surgery.ELISA was used to detect the levels of brain natriuretic peptide and cardiac troponin Ⅰ in serum.Western blot assay was used to detect the protein expression of LC3B,Beclin-1,and p62 in myocardial tissue.Hematoxylin-eosin staining was used to observe the pathological changes in myocardial tissue.Ultrasound was used to evaluate the cardiac function of mice.RESULTS AND CONCLUSION:(1)Compared with the sham operation group,there was no significant difference in the levels of serum brain natriuretic peptide,cardiac troponin Ⅰ,and the protein expression of myocardial autophagy proteins LC3Ⅱ/LC3Ⅰ and p62 in the sham operation+emodin group(P＞0.05).(2)Compared with the sham operation+emodin group,the levels of serum brain natriuretic peptide and cardiac troponin I were significantly increased in the model group(P＜0.05).Compared with the model group,the levels of serum brain natriuretic peptide and cardiac troponin I were decreased in the model+emodin group(P＜0.05).(3)Compared with the model group,the expression of LC3Ⅱ/LC3Ⅰ and Beclin-1 protein was increased and the expression of p62 protein was decreased in the myocardial tissue of the model+emodin group(P＜0.05).Compared with the model+emodin group,the expression of LC3Ⅱ/LC3Ⅰ and Beclin-1 protein decreased and the expression of p62 protein increased in the emodin+3-methyladenine group(P＜0.05).(4)The myocardial fibers in the sham operation group were normal,the myocardial fibers in the model group were disordered with a large number of inflammatory cell infiltration,the myocardial fibers in the model+emodin group were slightly disordered,and some vacuolar changes were observed.The myocardial fibers were disordered,and more inflammatory cell infiltration was observed in the emodin+3-methyladenine group.(5)Compared with the sham operation group,the left ventricular short axis shortening rate and left ventricular ejection fraction were decreased in the model group(P＜0.05).Compared with the model group,the left ventricular short axis shortening rate and left ventricular ejection fraction were increased in the model+emodin group(P＜0.05).Compared with the model+emodin group,the left ventricular ejection fraction of emodin+3-methyladenine group was decreased(P＜0.05),and the left ventricular short axis shortening rate was reduced but not statistically significant(P＞0.05).(6)The above results indicate that emodin pretreatment can improve myocardial injury and myocardial dysfunction in septic mice by promoting autophagy.

Aim To investigate the effect of interdialytic serum potassium levels on thrombosis of autologous ar-teriovenous fistula(AVF)in patients with chronic kidney disease(CKD)on maintenance haemodialysis(MHD).Methods 159 CKD patients who underwent MHD in our hospital from October 2021 to October 2022 were retrospectively analyzed.They were divided into hyperkalemia group(n=53),normal serum potassium group(n=61)and hypokalemia group(n=45)according to the mean serum potassium level of patients with different dialysis intervals,and all patients were followed up for 1 year or followed up until AVF thrombosis.General datas were collected and the following indicators were detected at the time of patient enrolment,including biochemical indicators,inflammatory factors,ultrasound indicators of AVF and oxidative stress factors levels.Multifactorial Logistic regression equations were used to analyze the effects of clinical indicators on AVF thrombosis in MHD patients,receiver operating characteristic(ROC)curve was used to assess the predictive efficacy of clinical indicators on AVF thrombosis;And interval likelihood ratio was used to stratify interdialyt-ic serum potassium levels,and further observe whether the relationship was stability between AVF thrombosis and interdia-lytic serum potassium levels in MHD patients.Results Compared with the normal serum potassium group,the levels of C-reactive protein(CRP),intact parathyroid hormone(iPTH),procalcitonin(PCT),triglyceride(TG),malondial-dehyde(MDA),myeloperoxidase(MPO),brachial artery resistance index(RI),brachial artery pulsatility index(PI)and radial artery PI were significantly elevated in hyperkalemia group and hypokalemia group,while the levels of albumin(Alb),total cholesterol(TC),superoxide dismutase(SOD)and fistula blood flow were significantly reduced(P＜0.05).Systolic blood pressure,diastolic blood pressure,fistula blood flow,Alb and SOD levels were significantly lower in patients with AVF thrombosis than those in patients with AVF unthrombosis(P＜0.05);Interdialytic mean serum potassium level,CRP,iPTH,PCT,brachial artery RI,brachial artery PI,radial artery PI,radial artery RI,MDA and MPO levels were significantly higher in patients with AVF thrombosis(P＜0.05).The ROC curve was used to analyse the model estab-lished by the multifactorial Logistic regression equation,and it was found that model 1 and model 2 had good predictive effi-cacy,and model 2 had the best predictive efficacy.The results of the interval likelihood ratio showed that:when the patient's interdialytic serum potassium level was 3.5～4.5 mmol/L,the possibility of the patient's AVF thrombosis was the lowest,and when the patient's interdialytic serum potassium level was＞5.5 mmol/L or＜3.5 mmol/L,the possibility of the patient's AVF thrombosis was higher,and when the patient's serum potassium level was＞5.5 mmol/L,the probability of AVF thrombosis was the highest in patients,which was 3.925 times higher than that of patients without AVF thrombosis.Conclusion Abnormal interdialytic serum potassium levels may induce AVF thrombosis in CKD patients.Serum potassium levels can be monitored during MHD treatment to enable timely intervention and improve clinical treatment outcomes for patients.

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.

In recent years, targeted therapy and immunotherapy have been applied more and more widely in tumor treatment, and reports on psoriasis induced or exacerbated by these drugs have emerged continuously. This review summarizes and evaluates targeted therapeutic drugs and immunotherapeutic drugs that allegedly induce or aggravate psoriasis according to their targets and possible mechanisms, including programmed death receptor 1 inhibitors, epidermal growth factor receptor inhibitors, human epidermal growth factor receptor 2 inhibitors, anti-CD20 monoclonal antibodies, phosphoinositide 3-kinase δ inhibitors and multi-targeted drugs. In most cases, the relationships between drugs and the occurrence of psoriasis are possible or probable, and in only a few cases the causality is certain.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objective To explore the effect of miR-1-3p on the malignant biological behavior of human esophageal squamous cell carcinoma cells and the potential mechanisms.Methods The Gene Expression Omnibus(GEO)database was analyzed to screen differentially expressed miRNAs in esophageal squamous cell carcinoma(ESCC).qRT-PCR was used to detect the expression of miR-1-3p in human ESCC cell lines(KYSE30,KYSE150,KYSE410,KYSE510,and Eca109)and normal esophageal epithelial cell line HET-1A.CCK-8,wound healing,Transwell assays,and flow cytometry were applied to detect the effect of miR-1-3p on the proliferation,migration,invasion,and apoptosis of ESCC cells.Bioinformatics tool was used to predict the target genes of miR-1-3p.A Kaplan-Meier survival curve was drawn to analyze the correlation between STC2 expression and overall survival of patients in the ESCC cohort of the TCGA database.Fluorescence in situ hybridization was performed to verify the subcellular location of miR-1-3p in ESCC cells,and dual-luciferase reporter gene assay was performed to validate the regulation of miR-1-3p on stanniocalcin 2(STC2).RNA immunoprecipitation assays were used to detect the binding of miR-1-3p and STC2.Western blot assay was performed to determine the effect of miR-1-3p on the expression of STC2 and endoplasmic reticulum stress pathway-related proteins,including p-PERK,p-eIF2α,and ATF4.CCK-8,wound healing,Transwell assays,and flow cytometry were applied to detect the effect of STC2 overexpression and knockdown on the proliferation,migration,invasion,and apoptosis of ESCC cells.Results The expression of miR-1-3p was lower in ESCC cell lines than in HET-1A cells(all P<0.05).The transfection of miR-1-3p mimic decreased the proliferation,invasion,and migration of ESCC cells(all P<0.05)and promoted the apoptosis of ESCC cells(all P<0.001).Bioinformatics tool showed that STC2 was a target gene of miR-1-3p.The expression of STC2 in ESCC tissues was higher than that in normal esophageal epithelial tissues in the ESCC cohort of TCGA database and was negatively correlated with prognosis(all P<0.05).miR-1-3p was located in the cytoplasm and can directly bind to STC2 mRNA.The transfection of miR-1-3p mimic downregulated the expression of STC2,p-PERK,p-eIF2α,and ATF4(all P<0.05).The overexpression of STC2 promoted the proliferation,invasion,and migration(all P<0.05)and inhibited the apoptosis of ESCC cells(all P<0.05).Knockdown of STC2 inhibited the proliferation,invasion,and migration(all P<0.05)and promoted the apoptosis of ESCC cells(all P<0.05).Conclusion miR-1-3p inhibits the malignant biological behavior and promotes the apoptosis of esophageal squamous cell carcinoma cells by regulating STC2 possibly by suppressing the endoplasmic reticulum stress.

Objective To investigate the effect of blue light on the dioptric development of the eyes of lens-induced myopia(LIM)guinea pigs.Methods Three-week-old trichromatic guinea pigs were randomly divided into three groups:control group,white light LIM(WL)group,and blue light LIM(BL)group(420 nm LED light,with an illuminance of 700 lx);guinea pigs in the latter two groups wore-10.00 D lenses in their right eyes to induce myopia.All guinea pigs under-went a 12 h light/12 h dark treatment cycle.Before and 2,4 weeks after the intervention,the diopter,axial length,retinal thickness and choroidal thickness were measured in all groups.After 4 weeks of intervention,the corneal fluorescent stai-ning and retinal Hematoxylin and Eosin(HE)staining were conducted.Results Compared with the control group,from week 0 to week 2 of the intervention(changes in weeks 0-2),the eyes in the WL group drifted(-2.22±1.28)D towards myopia,the axial length lengthened by(0.40±0.05)mm,and the retinal and choroidal thicknesses reduced by(-7.42± 7.04)μm and(-6.29±4.66)μm,respectively;compared with the WL group,in the BL group,the eyes drifted toward hyperopia by(0.48±1.16)D,the axial length increased by(0.20±0.10)mm,and retinal and choroidal thicknesses in-creased by(1.36±7.46)μm and(8.05±8.08)μm,respectively(all P＜0.05).From week 2 to week 4(changes in weeks 2-4),compared with the control group,the diopter in the WL and BL groups progressed towards myopia,with changes of(-4.64±0.50)D and(-2.11±2.02)D,respectively(both P＜0.05);the axial length lengthened,and reti-nal and choroidal thicknesses reduced in the WL group,with changes of(0.44±0.06)mm,(-7.35±5.87)μm and(-4.84±2.61)μm,while the choroidal thickness and the retinal thickness decreased in the BL group,with changes of(-0.33±5.95)μm and(-4.78±4.96)μm,respectively.Observations of corneal fluorescence staining and retinal HE staining indicated that prolonged blue light exposure could lead to damage to corneal and retinal cells.Conclusion Blue light may influence the development of myopia through choroid-related mechanisms,but its inhibitory effect is not positive-ly correlated with time.Prolonged exposure to blue light can damage the cornea and retina,thereby reducing the inhibitory effect.

【Objective】 To investigate the effect of double plasma molecular adsorption system and sequential half-dose plasma exchange (DPMAS+HPE) on the short-term survival rate of patients with hepatitis B associated acute-on-chronic liver failure (HBV-ACLF). 【Methods】 Data on HBV-ACLF cases hospitalized in our hospital from January 1, 2015 to December 31, 2022 were retrospectively collected, and were divided into standard comprehensive medical treatment group and DPMAS+HPE group according to different treatment methods. Propensity score matching (PSM) was used to eliminate inter group confounding bias. The baseline data and improvement of laboratory indicators after treatment between two groups were compared. Death related risk factors in HBV-ACLF patients were screened by logistic regression analysis, and cumulative survival rates at 30 and 90 days between the two groups were compared by Kaplan-Meier survival analysis. 【Results】 A total of 373 cases of HBV-ACLF were included in this study. Among them, 136 cases in the treatment group received DPMAS+HPE once on the basis of comprehensive internal medicine treatment, and 237 cases only received comprehensive internal medicine treatment. After PSM, 136 patients were included as the control group. The decrease in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total protein (TP) in the treatment group before and after treatment was significantly greater than that in the control group (446.5 vs 159.0, 317.0 vs 92.0,5.2 vs 0.3), with statistically significant difference (P<0.05). DPMAS+HPE treatment is an independent protective factor for mortality in HBV-ACLF patients at 30 and 90 days (30 days: OR=0.497, P<0.05; 90 days: OR= 0.436, P<0.05). The cumulative survival rates at 30 and 90 days in the treatment group were significantly higher than those in the control group (30 days: 50.71% vs 44.12%, P<0.05; 90 days: 30.15% vs 22.79%, P<0.05). 【Conclusion】 DPMAS+HPE improves the short-term prognosis of HBV-ACLF patients and can serve as an effective artificial liver model for the treatment of HBV-ACLF patients.