ObjectiveTo observe the clinical efficacy and safety of Shenshuai Guanchang prescription in improving the intestinal barrier function，reducing non-indole uremic toxins，ameliorating micro-inflammatory state，and delaying renal function progression in non-dialysis patients with chronic kidney disease （CKD） stage 4-5. MethodsA total of 80 patients with CKD stage 4-5 who did not receive dialysis replacement therapy and were diagnosed with the syndrome of spleen and kidney deficiency，blood stasis and dampness turbidity were randomly assigned into a control group and a treatment group，with 40 patients in each group. The control group received conventional basic treatment and Western medicine symptomatic treatment，while the treatment group received combined intervention with Shenshuai Guanchang prescription through retention enema in addition to the treatment of the control group. Both groups had a treatment course of 4 weeks. The two groups were compared regarding the changes in urine toxin indicators ［p-cresyl sulfate （PCS） and trimethylamine oxide （TMAO）］，intestinal barrier indicators ［D-lactic acid （D-LA），lipopolysaccharide （LPS），and intestinal fatty acid-binding protein （I-FABP）］，renal function indicators ［serum creatinine （SCr），blood urea nitrogen （BUN），and estimated glomerular filtration rate （eGFR）］，and micro-inflammatory state indicators ［interleukin-6 （IL-6），tumor necrosis factor-α （TNF-α），and neutrophil-to-lymphocyte ratio （NLR）］ before and after treatment. The therapeutic effects were evaluated from three aspects：The efficacy regarding traditional Chinese medicine （TCM） symptom scores，the efficacy regarding laboratory indicators，and comprehensive efficacy. The safety of the clinical research drugs used by both groups of patients was also observed. ResultsA total of 37 cases in the treatment group and 38 cases in the control group completed the observation. After treatment，the treatment group showed declined levels of PCS，TMAO，D-LA，SCr，TNF-α，and NLR，spleen and kidney deficiency symptom score，blood stasis and dampness symptom score，and total symptom score （P<0.05），and increased eGFR （P<0.05）. Moreover，the treatment group had lower levels of PCS，TMAO，D-LA，I-FABP，IL-6，and TNF-α，spleen and kidney deficiency symptom score，blood stasis and dampness symptom score，and total symptom score （P<0.05），higher response rate regarding TCM symptoms （χ²=6.68，P<0.05），and higher comprehensive efficacy （χ²=4.08，P<0.05） than the control group. No significant abnormalities were observed in the safety indicators of the two groups of patients. During the treatment period，adverse reactions were reduced after symptomatic treatment，and no serious adverse reactions occurred. ConclusionShenshuai Guanchang prescription can alleviate the clinical symptoms，improve the intestinal barrier function，reduce non-indole-type uremic toxins，alleviate the micro-inflammatory state，and has good clinical application safety of non-dialysis patients with CKD stage 4-5.

Objective:To compare the efficacy and safety of bi-level positive airway pressure (BiPAP) ventilation and heated humidified high flow nasal cannula (HHHFNC) ventilation as initial respiratory support for premature infants with respiratory distress syndrome (RDS).Methods:From January 2019 to June 2021, premature infants [gestational age (GA) 28~35 weeks)] with grade Ⅰ to Ⅲ RDS admitted to Suining County People's Hospital were prospectively enrolled. The infants were randomly assigned into BiPAP group and HHHFNC group. The clinical characteristics, ventilation efficacy and complications were analyzed.Results:A total of 33 infants were in BiPAP group and 32 in HHHFNC group. No significant differences existed between the two groups in the following items: the frequency of apnea within 24 h of ventilation, FiO 2 and PaCO 2 at 24 h, the use of pulmonary surfactant (PS), the incidence of non-invasive ventilation failure within 72 h, non-invasive ventilation duration and the age achieving total enteral nutrition. HHHFNC group had lower score in premature infants pain profile (PIPP) than BiPAP group at 24 h of non-invasive ventilation [4 (3, 6) vs. 8 (6, 11), P<0.001]. No significant differences existed in nasal injury, pneumothorax, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and mortality rate between the two groups ( P>0.05). Conclusions:As the initial treatment for premature infants with grade Ⅰ to Ⅲ RDS, BiPAP and HHHFNC has similar rates of non-invasive ventilation failure within 72 h,non-invasive ventilation duration and adverse events. HHHFNC may ease the pain of the infants.

OBJECTIVE: To study the chemical constituents of the roots of Angelica dahurica, a well-known Chinese herbal medicine named Baizhi in Chinese. METHODS: Compounds were separated by various chromatographies, and the structures of new compounds were elucidated based on the analysis of their spectroscopic and spectrometric data (1D, 2D NMR, HRESI MS, IR, and UV). The absolute configurations of new compounds were determined by the calculated electronic circular dichroism and chemical derivatization. The inhibitory activities of all isolates against nitric oxide (NO) production were evaluated using lipopolysaccharide-activated RAW 264.7 macrophage cells. RESULTS: Seven new 3,4-dihydro-furanocoumarin derivatives ( 1a/ 1b, 2a/ 2b, 3a/ 3b, 4) together with a known furanocoumarin ( 5) were isolated from the roots of A. dahurica. The new compounds included three pairs of enantiomers, (4S, 2''R)-angelicadin A ( 1a)/(4R, 2''S)-angelicadin A ( 1b), (4S, 2''S)-angelicadin A ( 2a)/(4R, 2''R)-angelicadin A ( 2b), and (4S, 2''S)-secoangelicadin A ( 3a)/(4R, 2''R)-secoangelicadin A ( 3b), together with (4R, 2''R)-secoangelicadin A methyl ester ( 4). The known xanthotoxol ( 5) inhibited the NO production with the half-maximal inhibitory concentration (IC₅₀) value of (32.8 ± 0.8) µmol/L, but all the new compounds showed no inhibitory activities at the concentration of 100 µmol/L. CONCLUSION This is the first report of the discovery of 3,4-dihydro-furanocoumarins from A. dahurica. The results are not only meaningful for the understanding of the chemical constituents of A. dahurica, but also enrich the reservoir of natural products.

Objective: To analyze the research hotspots of transitional care in patients with heart failure, and to provide reference for the development of related research in China. Methods: Based on the literature on transitional care for heart failure patients included in the Web of Science database, Use CiteSpace software to visualize research institutions, core journals, cited documents, and high-frequency keywords. Results: The current research in the field of transitional care for patients with international heart failure is mainly concentrated in colleges and universities in the United States. The core publications include Journals of The American Geriatrics Society and Bmc Health Services Research. Through keyword co-occurrence cluster analysis, the international hot topics of transitional care and discharge plan, readmission risk, quality improvement and quality of life in patients with heart failure were explored. Conclusion Hong Kong's transitional care research in patients with heart failure is more in-depth. Although the academic research of mainland China has increased, it has not yet reached the international frontier and needs further development and improvement.