More than 300 million people worldwide suffer from asthma, and the incidence is increasing year by year. As one of the most common chronic diseases, asthma is an immune-mediated inflammatory disease with complex triggering mechanisms and strong heterogeneity. With the in-depth study of physiological and pathological mechanisms, therapeutic small molecule and hormone drugs have been introduced to control and treat most patients, but about 5% - 10% of patients still suffer from various subtypes of difficult to control and treat asthma, that is, severe asthma. In the past decade, with the rapid development of bio-pharmaceutical research, protein and antibody have become the key drugs for the treatment of severe asthma with high efficacy, high specificity and high safety. However, biological drugs are usually administered by injection, they cannot be noninvasive and directly delivered into the lung to quickly absorb and take effect. Therefore, there is an urgent need for the introduction of inhaled biologics with quick effectiveness, convenience, economy and safety in clinical. The review summarizes the existing small molecule, hormone and biological therapy drugs, and summarizes the development of inhalable biological agents of asthma, and analyzes the future prospects of the inhalable biological drugs, which is designed to deepen the perception of the direction of the inhalable biological drugs research, and update the information of the field, in order to provide reference for the development of more inhalable biologics.

Objectives: . Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system. Methods: . We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables. Results: . The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16–2.57); were older (MD, 5.47 years, 95% CI, 2.44–8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33–2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56–3.44 cm); exhibited limited mouth opening (MD, −0.52 cm; 95% CI, −0.88 to −0.15 cm); had limited neck flexibility (MD, −10.05 cm; 95% CI, −14.10 to −6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07–5.48). Conclusion . We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

OBJECTIVES: Laryngeal cancer (LC) is a globally prevalent and highly lethal tumor. Despite extensive efforts, the underlying mechanisms of LC remain inadequately understood. This study aims to conduct an innovative bioinformatic analysis to identify hub genes that could potentially serve as biomarkers or therapeutic targets in LC. METHODS: We acquired a dataset consisting of 117 LC patient samples, 16 746 LC gene RNA sequencing data points, and 9 clinical features from the Cancer Genome Atlas (TCGA) database in the United States. We employed weighted gene co-expression network analysis (WGCNA) to construct multiple co-expression gene modules. Subsequently, we assessed the correlations between these co-expression modules and clinical features to validate their associations. We also explored the interplay between modules to identify pivotal genes within disease pathways. Finally, we used the Kaplan-Meier plotter to validate the correlation between enriched genes and LC prognosis. RESULTS: WGCNA analysis led to the creation of a total of 16 co-expression gene modules related to LC. Four of these modules (designated as the yellow, magenta, black, and brown modules) exhibited significant correlations with 3 clinical features: The age of initial pathological diagnosis, cancer status, and pathological N stage. Specifically, the yellow and magenta gene modules displayed negative correlations with the age of pathological diagnosis (r=-0.23, P<0.05; r=-0.33, P<0.05), while the black and brown gene modules demonstrated negative associations with cancer status (r=-0.39, P<0.05; r=-0.50, P<0.05). The brown gene module displayed a positive correlation with pathological N stage. Gene Ontology (GO) enrichment analysis identified 77 items, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis identified 30 related signaling pathways, including the calcium signaling pathway, cytokine-cytokine receptor interaction, neuro active ligand-receptor interaction, and regulation of lipolysis in adipocytes, etc. Consequently, central genes within these modules that were significantly linked to the overall survival rate of LC patients were identified. Central genes included CHRNB4, FOXL2, KCNG1, LOC440173, ADAMTS15, BMP2, FAP, and KIAA1644. CONCLUSIONS This study, utilizing WGCNA and subsequent validation, pinpointed 8 genes with potential as gene biomarkers for LC. These findings offer valuable references for the clinical diagnosis, prognosis, and treatment of LC.
Humans ; Laryngeal Neoplasms/genetics* ; Rosaniline Dyes ; Biomarkers ; Adipocytes ; Gene Regulatory Networks ; Gene Expression Profiling

Humans ; Gastrointestinal Microbiome ; Diabetes Mellitus, Type 2/complications* ; Cholelithiasis

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.

Objective: To observe the application of ultrasound-guided femoral nerve block(FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery. Methods: From August 2015 to August 2017, 60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People′s Hospital of Langfang were randomly divided into 3 groups by the random number table, with 20 cases in each group.Before transfer patients from bed to operating table, A group received dezocine 5 mg iv, B group received FNB combined with PSNB(distal to the sciatic nerve bifurcation), C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation). A total of 40 mL of 0.375% ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake, the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre- and post block.The incidence of sleepiness, postoperative nausea and vomiting (PONV), agitation, pain and adverse reaction were also recorded. Results: The time of sufficient sensory block and awake, the dosage of remifentanil and propofol in A, B and C group: A group(not measured), (21.6±1.6)min, (1183±17)μg, (665.0±6.7)mg; B group (25.5±2.5)min, (15.3±1.4)min, (635±16)μg, (455.0±6.5)mg; C group (19.6±2.3)min, (14.9±1.5)min, (598±14)μg, (438.0±9.9)mg.The time of awake, the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F=44.07, 52.41, 62.45, all P<0.05). The time of sufficient sensory block in C group was lower than that in B group(t=15.69, P<0.05). The VAS scores at T2, T3 and T4 in A, B and C group: A group (4.5±0.6)point, (8.4±0.5)point, (6.1±0.9)point; B group (2.6±0.5)point, (3.9±0.3)point, (2.4±0.6)point; C group (2.5±0.4)point, (2.3±0.5)point, (1.1±0.5)point.The VAS scores in B group or C group were significantly lower than those in A group (F=52.36, 72.82, 75.41, all P<0.05). The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t=18.42, q=14.55, all P<0.05). The incidence rates of sleepiness, PONV, agitation and incision pain in A, B and C group: A group (25%, 25%, 15%, 15%, 50%); B group(0%, 5%, 0%, 0%, 10%); C group(0%, 5%, 0%, 0%, 0%). The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (χ²=8.51, 8.73, 10.11, 10.11, 9.69, all P<0.05). The incidence rate of incision pain at sober in C group was lower than that in B group(χ²=10.89, P<0.05). Conclusion The ultrasound-guided FNB and PSNB(proximal to the sciatic nerve bifurcation) can obviously shorten the onset time, reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober.

Objective: To observe the application of ultrasound-guided fascia iliaca compartment block(FICB) and proximal popliteal sciatic nerve block(PPSNB) on patients undergoing total knee arthroplasty. Methods: From January 2015 to January 2018, 60 patients scheduled for total knee arthroplasty undergoing laryngeal mask airway(LMA) general anesthesia in the People′s Hospital of Langfang were divided into three groups by the random number table, with 20 cases in each group.Before general anesthesia, every patient received dezocine 5mg iv, group A received FICB, group B received FICB combined with PPSNB(extraparaneural), group C received FICB combined with PPSNB(subparaneural).40mL of 0.375% ropivacaine was injected guiding by ultrasound.The dosage of propofol and remifentanil, time of awake, awake visual analogue scale(VAS), mean arterial blood pressure(MAP) and heart rate(HR) at pre-block(T1), LMA insert(T2), skin incision(T3), femoral bone cutting(T4), LMA remove(T5), and awake stage(T6) were recorded.The incidence of using vasoactive drugs and adverse reaction were also recorded. Results: The dosage of propofol and remifentanil, the time of awake and awake VAS in group A, group B and group C were: group A (768.0±8.5)mg, (977±21)μg, (18.4±2.1)min, (4.2±0.7)points; group B (554.0±7.1)mg, (775±12)μg, (12.3±1.6)min, (2.4±0.6)points; group C (530±8.2)mg, (738±15)μg, (11.8±1.7)min, (1.3±0.5)points.The dosage of propofol and remifentanil, time of awake, awake VAS in group B and group C were significantly lower than those in group A (F=29.23, 42.56, 32.42, 19.31, all P<0.05). The awake VAS in group C was lower than that in group B (q=8.12, P<0.05). MAP and HR at T2, T3, T4, T5 and T6 in group B or group C were significantly lower than those in group A (MAP: F=85.66, 78.46, 86.04, 62.75, 61.31; HR: F=26.03, 42.75, 38.04, 29.31, 31.50, all P<0.05). The number of patients who required vasoactive drugs and adverse reaction in group B or group C were significantly lower than those in group A (χ²=11.32, 12.81, 15.24, 15.24, 10.15, all P<0.05). The incidence rates of incision pain at awake stage in group A, group B and group C were: group A(30%), group B(20%), group C(0%), that in group C was lower than group B (χ²=9.87, P<0.05). Conclusion The ultrasound-guided FICB and PPSNB(subparaneural) can obviously reduce the dosage of general anaesthetic and maintain the stability of hemodynamics in patients undergoing total knee arthroplasty.It has effective analgesia and less adverse reactions during sober.

Objective Based on the objective test (A type) results of the 2014 comprehensive clinical course graduation test of 3+2 assistant general practitioners training,this article analyzed the differences between different teaching units,so as to provide objective basis for improving the teaching level of each unit.Method We established a database with EXCEL 2000,and put each question's ID and points,and the score of each student into the computer,so we could get the difficulty coefficient,distinction degree and reliability of the test paper,and calculate the difficulty coefficient and difference of each question.Then we analyzed the difficulty coefficient,the difference and the reliability of the 122 students' testing results,and compared the accuracy to the same question of the 6 teaching units.Result The objective test's (A type) difficulty coefficient is 0.77,distinction degree is 0.19,and reliability is 0.99.The highest score of the 122 students is 47 points,and the lowest score is 28 points,the average score is (38.5 ± 3.9) points.In the 50 questions,3 questions' difficulty coefficient is less than 0.4,14 questions' difficulty coefficient is between 0.4-0.7,33 questions' difficulty coefficient is above 0.7,so the difficulty degree of the paper is relatively low.In the 50 questions,23 questions' distinction degree is less than 0.15,17 questions' distinction degree is between 0.15-0.30,10 questions' distinction degree is above 0.30,so the distinction degree of the paper is relatively high.In the 50 questions,20 questions' accuracy appears larger differences between each unit:9 questions' accuracy has decreased significantly among 1-2 units,4 questions' accuracy decreased significantly among 3 units,3 questions' accuracy decreased significantly among 4 units,only 1 unit has high accuracy among 2 questions,and 2 questions' accuracy decreased significantly among all units.These problems are related to the teachers' teaching ability,the difficulty in mastering the key points of the curriculum,the lack of the concept of the general practitioners training.Conclusion The design of the examination paper is basically in line with the study purpose and the objectives of the training course.This examination paper was highly reliable,and suitable for the professional theory and ability test.There are site differences between each unit,which can provide an objective basis for improving the teaching level of different teaching unit,and we will solve the problems in the form of collective preparation next step.

Objective:To investigate the effects of moxibustion on the serum metabolism in healthy human body based on the 1H nuclear magnetic resonance (1H NMR) metabolomics technology, and to find the differences in metabolites, as well as to elucidate the effects of moxibustion on healthy human body from the viewpoint of global metabolism. Methods:Sixty subjects of healthy young men from the enrolled students were randomly divided into a moxibustion group and a control group using random number table, with 30 cases in each group. Subjects in the moxibustion group accepted mild moxibustion on the right Zusanli (ST 36), once a day, 15 min for each time, and continuous treatment for 10 d; those in the control group did not receive any intervention. There were 28 cases in the moxibustion group and 23 cases in the control group after interventions. On the 1st day, 5th day and 10th day of the intervention, serum samples were collected from subjects of the two groups, and metabolic spectra were obtained by the1H NMR technology. Results: Before and after the intervention, serum1H NMR of the moxibustion group was significantly different, while the difference was insignificant in the control group. Metabolite changes in the moxibustion group were mainly in low density lipoprotein (LDL)/very low density lipoprotein (VLDL), valine, isoleucine, leucine, lactic acid, glutamine, citric acid, polyunsaturated fatty acids, creatine, glycine, glycerol, glucose, tyrosine, histidine, formic acid, alanine, lysine, acetic acid, and glutamic acid. Conclusion:Moxibustion can cause changes of serum metabolic patterns in healthy human by influencing the concentrations of branched-chain amino acids, polyunsaturated fatty acids, and other metabolites to strengthen body's metabolisms of amino acids and fatty acid.