OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

ObjectiveTo explore the effects and mechanism of the modified Danggui Yinzi on "itch-anxiety" model rats of chronic urticaria （CU）. MethodsThe 36 SPF-grade 6-8-week-old female SD rats were randomly divided into a blank control group，a model group，a positive control group，a low-dose modified Danggui Yinzi group，a medium-dose modified Danggui Yinzi group，and a high-dose modified Danggui Yinzi group. A "itch-anxiety" model was established by intraperitoneal injection of a suspension of sodium chloride and aluminum hydroxide and ovalbumin，combined with chronic unpredictable emotional stress stimulation. After successful modeling，rats in each group were administered drugs by gavage. The positive control group was given intragastric administration of the drug solutions of cetirizine and fluoxetine （2.08 mg·kg^-1·d^-1 fluoxetine， 2 mg·kg^-1·d^-1 cetirizine）， the low-，medium-，and high-dose modified Danggui Yinzi groups were administered traditional Chinese medicine at 1.44，2.88， 5.76 g·kg^-1， respectively，while the blank control group and model group were given an equal volume of normal saline. All interventions lasted for 15 days. Behavioral changes were evaluated by the elevated plus-maze test （detecting the percentage of entries into the open arms （OE%），the percentage of time spent in the open arms （OT%），and the total number of entries into the open and closed arms （TNE）），the open-field test （detecting total activity，average movement speed，and latency to enter the central area），and scratching behavior observation. Pathological changes of skin tissues were observed by hematoxylin-eosin （HE） staining and toluidine blue staining，while those of amygdala tissues were observed by HE staining，Nissl staining，and immunofluorescence detection of ionized calcium-binding adapter molecule-1 （Iba-1）. The content of immunoglobulin E （IgE），interleukin-33 （IL-33），histamine in serum and glutamate in the amygdala was detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the protein expression of striatal-enriched protein tyrosine phosphatase （STEP），N-methyl-D-aspartate receptor subunit 2B （NR2B）， calmodulin-dependent protein kinase Ⅱ （CaMKⅡ），phosphorylated CaMKⅡ （p-CaMKⅡ），mitogen-activated protein kinase （MAPK），phosphorylated MAPK （p-MAPK），nuclear factor kappa-light-chain-enhancer of activated B cells （NF-κB），phosphorylated NF-κB （p-NF-κB），and postsynaptic density protein-95 （PSD-95） in the amygdala. ResultsCompared with the blank control group，the model group rats showed obvious anxiety-like behaviors （decreased OE%，OT%，and TNE，reduced total activity，slower average movement speed，and prolonged latency to enter the central area），increased scratching times，obvious skin inflammation and mast cell degranulation，severe amygdala tissue damage，increased glutamate content in the amygdala，and elevated levels of IgE and IL-33 in serum. The expression of STEP，NF-κB，p-NF-κB，NR2B，MAPK，p-MAPK，CaMKⅡ，and p-CaMKⅡ proteins in the amygdala increased，while the expression of PSD-95 protein decreased （P<0.05）. Compared with the model group，the modified Danggui Yinzi group of each dose had increased OE%，OT%，TNE，total activity，and average movement speed，shortened latency to enter the central area， reduced scratching times，alleviated skin inflammation and mast cell degranulation，relieved amygdala tissue damage，decreased glutamate content in the amygdala，and reduced levels of IgE and IL-33 in serum. Moreover，compared with the model group，the low -，medium-，and high-dose modified Danggui Yinzi groups showed decreased expression levels of STEP，NF-κB，p-NF-κB，NR2B，MAPK，p-MAPK，CaMKⅡ，and p-CaMKⅡ proteins in the amygdala，and increased expression of PSD-95 protein. There was a significant dose-effect relationship，with the high-dose group showing the most significant regulatory effect （P<0.05）. ConclusionThe modified Danggui Yinzi has a therapeutic effect on "itch-anxiety" model rats of CU. Its mechanism may be related to regulating glutamate metabolism in the amygdala，modulating the STEP/NR2B/CaMKⅡ/MAPK/NF-κB pathway，and regulating the expression of PSD-95.

Objective To observe the dynamic changes in serum levels of IL-6,IL-8,TREM-1,uPAR,and presepsin in patients with septic shock and to analyze the diagnostic significance of these biomarkers.Methods A total of 150 sepsis patients admitted to the hospital between February 2023 and February 2025 were prospectively enrolled as study subjects.According to their clinical conditions,the participants were categorized into a sepsis group(non-shock,n=44)and a septic shock group(n=106).Additionally,30 healthy individuals with normal clinical indicators during the same period were selected as the control group.The serum levels of IL-6,IL-8,TREM-1,uPAR,and presepsin were measured and compared across the different groups.Spearman correlation analysis and logistic regression analysis were conducted to assess the association between these biomarkers and the severity of sepsis.The diagnostic performance of these biomarkers for septic shock was evaluated using receiver operating characteristic(ROC)curve analysis.Results There were statistically significant differences in serum levels of IL-6,IL-8,TREM1,uPAR,and presepsin among the different groups(P<0.05),with the highest values observed in the septic shock group,followed by the sepsis group and the control group(P<0.05).The APACHE Ⅱ and SOFA scores of patients with septic shock were significantly higher than those of patients with sepsis(P<0.05).Spearman correlation analysis revealed that serum concentrations of IL-6,IL-8,TREM1,uPAR,and presepsin were positively correlated with both APACHE Ⅱ and SOFA scores,with correlation coeffi-cients(rs)of 0.758,0.880,0.837,0.832,and 0.846 for APACHE Ⅱ score,and 0.487,0.549,0.557,0.626,and 0.664 for SOFA score,respectively(P<0.05).Logistic regression analysis indicated that serum levels of IL-6(OR=1.055),IL-8(OR=1.054),TREM1(OR=1.038),uPAR(OR=1.010),and presepsin(OR=2.103)were significantly associated with the development of septic shock(P<0.05).ROC curve analysis demonstrated that the AUC values for serum IL-6,IL-8,TREM1,uPAR,and presepsin in diagnosing septic shock were 0.608,0.724,0.887,0.848,and 0.885,with corresponding sensitivities of 0.432,0.909,0.795,0.909,and 0.591,and specificities of 0.880,0.481,0.915,0.736,and 0.977,respectively.When these biomarkers were combined,the AUC increased to 0.973,with a sensitivity of 0.943 and a specificity of 0.953.Furthermore,the AUC for prese-psin alone was significantly higher than that for IL-6 and IL-8 alone(P<0.05).Additionally,the AUC for the combined biomarkers was significantly greater than that for each biomarker individually(P<0.05).Conclusions Serum levels of IL-6,IL-8,TREM1,uPAR,and presepsin are significantly elevated in patients with septic shock,which may aid in the clinical diagnosis of the condition.The combined use of these five biomarkers en-hances the accuracy of diagnosing septic shock.

Objective To observe the dynamic changes in serum levels of IL-6,IL-8,TREM-1,uPAR,and presepsin in patients with septic shock and to analyze the diagnostic significance of these biomarkers.Methods A total of 150 sepsis patients admitted to the hospital between February 2023 and February 2025 were prospectively enrolled as study subjects.According to their clinical conditions,the participants were categorized into a sepsis group(non-shock,n=44)and a septic shock group(n=106).Additionally,30 healthy individuals with normal clinical indicators during the same period were selected as the control group.The serum levels of IL-6,IL-8,TREM-1,uPAR,and presepsin were measured and compared across the different groups.Spearman correlation analysis and logistic regression analysis were conducted to assess the association between these biomarkers and the severity of sepsis.The diagnostic performance of these biomarkers for septic shock was evaluated using receiver operating characteristic(ROC)curve analysis.Results There were statistically significant differences in serum levels of IL-6,IL-8,TREM1,uPAR,and presepsin among the different groups(P<0.05),with the highest values observed in the septic shock group,followed by the sepsis group and the control group(P<0.05).The APACHE Ⅱ and SOFA scores of patients with septic shock were significantly higher than those of patients with sepsis(P<0.05).Spearman correlation analysis revealed that serum concentrations of IL-6,IL-8,TREM1,uPAR,and presepsin were positively correlated with both APACHE Ⅱ and SOFA scores,with correlation coeffi-cients(rs)of 0.758,0.880,0.837,0.832,and 0.846 for APACHE Ⅱ score,and 0.487,0.549,0.557,0.626,and 0.664 for SOFA score,respectively(P<0.05).Logistic regression analysis indicated that serum levels of IL-6(OR=1.055),IL-8(OR=1.054),TREM1(OR=1.038),uPAR(OR=1.010),and presepsin(OR=2.103)were significantly associated with the development of septic shock(P<0.05).ROC curve analysis demonstrated that the AUC values for serum IL-6,IL-8,TREM1,uPAR,and presepsin in diagnosing septic shock were 0.608,0.724,0.887,0.848,and 0.885,with corresponding sensitivities of 0.432,0.909,0.795,0.909,and 0.591,and specificities of 0.880,0.481,0.915,0.736,and 0.977,respectively.When these biomarkers were combined,the AUC increased to 0.973,with a sensitivity of 0.943 and a specificity of 0.953.Furthermore,the AUC for prese-psin alone was significantly higher than that for IL-6 and IL-8 alone(P<0.05).Additionally,the AUC for the combined biomarkers was significantly greater than that for each biomarker individually(P<0.05).Conclusions Serum levels of IL-6,IL-8,TREM1,uPAR,and presepsin are significantly elevated in patients with septic shock,which may aid in the clinical diagnosis of the condition.The combined use of these five biomarkers en-hances the accuracy of diagnosing septic shock.

To further standardize the management of postoperative nausea and vomiting in China, the Chinese Society of Anesthesiology initiated the development of Clinical practice guidelines on postoperative nausea and vomiting(2024 edition). The guideline development strictly adhered to internationally recognized principles. This protocol primarily described the methodology and process of guideline formulation, including essential information, background, objectives, development principles, task force and responsibilities, selection of clinical question, evidence acquisition, evidence evaluation, and expert consensus formulation.

Objective:To construct a quality indicator system for pain nursing process in adult inpatients and to provide a scientific, objective and practical basis for the evaluation and management of pain nursing quality in clinical nursing.Methods:Based on the guidance framework of nursing procedures, a quality index system for pain nursing process in adult inpatients was preliminarily developed. Two rounds of expert questionnaires were conducted using the Delphi method, the analytic hierarchy process was used to analyze the weight of the indicators, and the semantic analysis of the indicator system was carried out with the nurses, and finally the quality indicator system for the pain nursing process in adult inpatients was constructed.Results:Both Delphi rounds attained 100% response rates, and the expert authority coefficients were 0.96 and 0.98 respectively, the familiarity coefficients were 0.95 and 0.98 respectively, both judgment basis coefficients were 0.98, and the Kendall′s coefficient of concordance were 0.187 and 0.451 respectively. The mean values of each indicator in semantic analysis ranged from 4.30 to 5.00, and the standard deviation was 0-1.06. The final constructed quality indicator system for the pain nursing process in adult inpatients included 5 primary-level indicators (pain assessment, pain nursing diagnosis, pain nursing plan, pain nursing measures, and pain nursing evaluation) and 28 secondary-level indicators.Conclusions:The quality indicator system for the pain nursing process is successfully constructed in adult inpatients, the method is scientific and reasonable, and the content is practical and reliable. It has guiding significance for evaluating the quality of pain nursing process for inpatients.

Objective: To investigate treatment strategies for chronic periapical periodontitis in prematurely erupted premolars and provide guidance for managing pulp and periapical diseases in young permanent teeth with immature roots. Methods: A regenerative endodontic procedure (REP) was performed on a prematurely erupted maxillary left first premolar (tooth 24) at Nolla stage Ⅶ with chronic apical periodontitis, following standardized protocols including root canal irrigation, disinfection, and coronal sealing. The case was followed up, and a literature review was conducted. Results: Clinical resolution of symptoms was observed on tooth 24, with sustained root development. After a 20-month follow-up, the tooth had restored biological function. Literature synthesis revealed that periapical infections in prematurely erupted permanent teeth predominently arise from pulp exposure and bacterial infection, with retrograde infection being rare. For young permanent teeth with necrotic pulp, regenerative endodontic procedures has been established as the treatment of choice to promote apical closure and root maturation. The critical steps of regenerative endodontic procedures include thorough disinfection, induced bleeding to form a fibrin scaffold, and coronal sealing to facilitate stem cell recruitment and differentiation. Conclusion Regenerative endodontic procedures represents an effective and viable treatment option for prematurely erupted young permanent teeth with chronic periapical periodontitis.

To further standardize the management of postoperative nausea and vomiting in China, the Chinese Society of Anesthesiology initiated the development of Clinical practice guidelines on postoperative nausea and vomiting(2024 edition). The guideline development strictly adhered to internationally recognized principles. This protocol primarily described the methodology and process of guideline formulation, including essential information, background, objectives, development principles, task force and responsibilities, selection of clinical question, evidence acquisition, evidence evaluation, and expert consensus formulation.

Objective:To construct a quality indicator system for pain nursing process in adult inpatients and to provide a scientific, objective and practical basis for the evaluation and management of pain nursing quality in clinical nursing.Methods:Based on the guidance framework of nursing procedures, a quality index system for pain nursing process in adult inpatients was preliminarily developed. Two rounds of expert questionnaires were conducted using the Delphi method, the analytic hierarchy process was used to analyze the weight of the indicators, and the semantic analysis of the indicator system was carried out with the nurses, and finally the quality indicator system for the pain nursing process in adult inpatients was constructed.Results:Both Delphi rounds attained 100% response rates, and the expert authority coefficients were 0.96 and 0.98 respectively, the familiarity coefficients were 0.95 and 0.98 respectively, both judgment basis coefficients were 0.98, and the Kendall′s coefficient of concordance were 0.187 and 0.451 respectively. The mean values of each indicator in semantic analysis ranged from 4.30 to 5.00, and the standard deviation was 0-1.06. The final constructed quality indicator system for the pain nursing process in adult inpatients included 5 primary-level indicators (pain assessment, pain nursing diagnosis, pain nursing plan, pain nursing measures, and pain nursing evaluation) and 28 secondary-level indicators.Conclusions:The quality indicator system for the pain nursing process is successfully constructed in adult inpatients, the method is scientific and reasonable, and the content is practical and reliable. It has guiding significance for evaluating the quality of pain nursing process for inpatients.

Anxiety disorder is a highly prevalent psychological illness, and research has shown that obesity is a significant risk factor for its development. This study explored the ameliorative effects and mechanisms of saponins from Panax japonicus(SPJ) on anxiety disorder in mice fed a high-fat diet(HFD). Fifty C57BL/6J mice were randomly divided into normal control diet(NCD) group, HFD group, and low-and high-dose SPJ groups. At week 12, six mice from the HFD group were further divided into a control group(treated with DMSO) and an exogenous fibroblast growth factor 21(FGF21) group(administered rFGF21). The anxiety-like behavior of the mice was assessed using the open field test and elevated plus maze test. Hematoxylin-eosin(HE) staining and oil red O staining were performed to observe pathological changes in the liver and adipose tissue. Glucose metabolism was evaluated through the glucose tolerance test(GTT) and insulin tolerance test(ITT). Western blot analysis was performed to detect the expression of FGF21 and its downstream-related proteins in the liver and cortex, along with the expression of brain-derived neurotrophic factor(BDNF), disks large homolog 4(DLG4), and synaptophysin(SYP) in the cortex. Real-time quantitative fluorescent PCR(qPCR) was used to detect the expression of FGF21 and its receptor genes in the liver and cortex. Immunofluorescence staining was employed to examine the expression of neuronal activator c-Fos, FGF21, and the FGF21 co-receptor β-klotho in the cerebral cortex. The results showed that SPJ significantly improved the frequency of activity in the open arms of the elevated plus maze and the central area of the open field in HFD mice, up-regulated the expression of BDNF, DLG4, and SYP, and effectively alleviated anxiety-like behaviors in HFD mice. Compared with the NCD group, HFD mice exhibited up-regulated expression of FGF21 in the liver and cerebral cortex, while the expression of fibroblast growth factor receptor 1(FGFR1) and β-klotho was significantly down-regulated, suggesting that HFD mice exhibited FGF21 resistance. SPJ markedly up-regulated the β-klotho levels in HFD mice, reversing FGF21 resistance. Further comparison with exogenously administered FGF21 revealed that SPJ activates brain cortical regions in a consistent manner, and additionally, SPJ promotes the number and colocalization of c-Fos and β-klotho positive cells in the brain cortex. In summary, SPJ effectively alleviates anxiety-like behaviors in HFD mice. Its mechanism is associated with up-regulation of β-klotho expression in the brain, reversal of FGF21 resistance, and subsequent activation of neurons in the cerebral cortex and amygdala.
Animals ; Diet, High-Fat/adverse effects* ; Fibroblast Growth Factors/genetics* ; Mice ; Male ; Panax/chemistry* ; Mice, Inbred C57BL ; Anxiety/etiology* ; Saponins/administration & dosage* ; Brain-Derived Neurotrophic Factor/genetics* ; Humans ; Liver/metabolism* ; Drugs, Chinese Herbal/administration & dosage*