ObjectiveTo investigate the effect of icariin （ICA） on the phenotype of dendritic cells （DCs） in heart tissue of the Dahl salt-sensitive myocardial remodeling model of rats and its regulation on the vitamin D system. MethodsMale Dahl salt-resistant rats were divided into a normal group， and male Dahl salt-sensitive rats were divided into a model group， low-， medium-， and high-dose ICA groups （30， 60， 120 mg·kg^-1·d^-1）， and Vitamin D group （3×10^-5 mg·kg^-1·d^-1）. In addition to the normal group， the other groups were given an 8% high salt diet to establish a myocardial remodeling model and received intragastric administration after successful modelling once a day for six weeks. The dynamic changes in tail artery blood pressure were monitored， and detection of cardiac ultrasound function in rats was performed. Hematoxylin-eosin （HE） staining and Masson staining were used to observe the morphological changes in rat heart tissue. The phenotype of DCs and T helper cell 17 （Th17）/regulatory T cell （Treg） ratio were detected by flow cytometry. The mRNA and protein expression of vitamin D receptor （VDR）， 1α-hydroxylase （CYP27B1）， 24-hydroxylase （CYP24A1）， forkhead frame protein 3 （FoxP3）， solitaire receptor γt （RORγt）， myocardial type Ⅰ collagen （ColⅠ）， and type collagen （ColⅢ） in heart tissue was detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot. ResultsCompared with the normal group， the model group showed disordered arrangement and rupture of myocardial cells， nuclear condensation， significant edema of myocardial tissue， significant proliferation of collagen fibers in a network distribution， and a significant increase in tail artery blood pressure， left ventricular end diastolic diameter （LVEDD）， and left ventricular end systolic diameter （LVESD） （P<0.05）. The phenotype of cardiac DCs was CD40， CD80， and CD86， and the levels of major histocompatibility complex Ⅱ （MHC-Ⅱ）， Th17 cells， and Th17/Treg were significantly increased （P<0.05）. The mRNA and protein expression of CYP24A1 and RORγt in the heart， as well as the mRNA expression of ColⅠ and ColⅢ， were significantly increased （P<0.05）. The left ventricular ejection fraction （LVEF）， interventricular septal thickness （IVSD）， and left ventricular posterior wall thickness （LVPWD） were significantly decreased （P<0.05）. The phenotype of cardiac DCs such as CD11， CD11b， and Treg cells， were significantly reduced （P<0.05）， while the mRNA and protein expression of cardiac VDR， CYP27B1， and FoxP3 were significantly decreased （P<0.05）. Compared with the model group， the low-， medium-， and high-dose ICA groups and vitamin D group significantly reduced myocardial cell rupture and nuclear consolidation in rats. The high-dose ICA group and vitamin D group showed a small amount of myocardial cell rupture and nuclear consolidation， improving myocardial fiber arrangement to varying degrees and significantly reducing myocardial fiber rupture and proliferation. The tail artery blood pressure， LVEDD， and LVESD were significantly decreased in the low-， medium-， and high-dose ICA groups and vitamin D group （P<0.05）， and the phenotype of cardiac DCs including CD40， CD80， CD86， MHC-Ⅱ， Th17 cells， and Th17/Treg were significantly decreased （P<0.05）. The mRNA and protein expression of CYP24A1 and RORγt， and the mRNA expression of ColⅠ and ColⅢ in the heart were significantly decreased in the medium- and high-dose ICA groups and vitamin D group （P<0.05）. The LVEF， IVSD， and LVPWD of myocardial remodeling model rats in the low-， medium-， and high-dose ICA groups and vitamin D group were significantly increased （P<0.05）. The phenotypes of cardiac DCs including CD11， CD11b， and Treg cells were significantly increased in the medium- and high-dose ICA groups and the Vitamin D group （P<0.05）. The mRNA and protein expressions of VDR， CYP27B1， and FoxP3 in the heart were significantly increased in the medium- and high-dose ICA groups and vitamin D group （P<0.05）. ConclusionICA can regulate tail artery blood pressure， cardiac structural and functional damage， and myocardial tissue fibrosis and inhibit phenotype and functional maturation of DCs in heart tissue in the myocardial remodeling model of Dahl salt-sensitive rats. It can also affect the gene and protein expression of VDR， CYP24A1， and CYP27B1， achieving its intervention in Th17/Treg balance in the immune process of myocardial remodeling possibly by regulating vitamin D/VDR in heart tissue.

Objectives:To explore the predictive value of residual Murray's law-based quantitative flow ratio(μQFR)on long-term vessel-oriented composite endpoints(VoCE).Methods:This retrospective study included 3 510 patients from the FAVOR Ⅲ China trial.Offline residual μQFR analysis was performed on all vessels(diameter≥2.5 mm)with 50%-90%stenotic lesions.Patients were stratified into high-,intermediate-,and low-risk groups based on residual μQFR tertiles.The primary endpoint was 3-year VoCE,defined as a composite of cardiac death related to the target vessel,target vessel-related spontaneous myocardial infarction,and ischemia-driven target vessel revascularization.Results:Offline analysis was performed on 5 256 vessels from 3 510 patients.The mean residual μQFR was 0.92±0.75.The high-risk group(residual μQFR≤0.91)with 1 554 patients(1 958 vessels);the intermediate-risk group(residual μQFR 0.92-0.96)with 1 211 patients(1 906 vessels);and the low-risk group(residual μQFR>0.96)with 745 patients(1 392 vessels).Over 3-year follow-up,VoCE occurred in 227 vessels(4.3%).The 3-year VoCE incidence was significantly higher in the high-risk group compared to the intermediate-and low-risk groups(6.2%vs.4.1%vs.2.5%,log-rank P<0.001),primarily driven by ischemia-driven target vessel revascularization(5.0%vs.3.0%vs.1.6%,log-rank P<0.001).Hypertension(OR=0.83,95%CI:0.72-0.96),hypercholesterolemia(OR=0.84,95%CI:0.73-0.97),bifurcation lesions(OR=0.72,95%CI:0.63-0.83),moderate/severe calcification(OR=0.70,95%CI:0.57-0.84),and tandem lesions(OR=0.59,95%CI:0.47-0.75)were independent predictors of lower residual μQFR values.Conclusions:Lower residual μQFR is significantly associated with increased VoCE risk during the 3-year follow up period.

With the holistic concept of traditional Chinese medicine(TCM)as the foundation,Professor ZHOU Yunfeng proposes the three-part Tuina(Chinese therapeutic massage)manipulation to treat insomnia by"taking the head and brain as the essential and simultaneously regulating the abdomen and back".Taking the theories of Ying-nutrient and Wei-defensive Qi,Zang-Fu organs,and meridians as evidence,this method primarily regulates the mind and concurrently modulates Zang-Fu organs.The three-part Tuina manipulation regulates the spirit by grasping the five meridians(Governor Vessel,Bladder Meridian of Foot Taiyang,and Gallbladder Meridian of Foot Shaoyang)and stimulating points such as Baihui(GV20),Yintang(GV29),Taiyang(EX-HN5),and Shenting(GV24);it regulates the abdomen by selecting Zhongwan(CV12),Shenque(CV8),Qihai(CV6),and Guanyuan(CV4),which means to calm the mind by regulating spleen-stomach Qi activities;it treats the back by selecting Jianjing(GB21),Xinshu(BL15),Pishu(BL20),Weishu(BL21),and Shenshu(BL23),which means to calm the mind by regulating Qi activities of the whole body.Mind regulation runs through the whole process of this manipulation,which combines points from three body regions to produce a synergistic effect,concurrently treating the three body parts,i.e.,the head,abdomen,and back,to mitigate the clinical symptoms and improve sleep quality in insomniacs.

Extracellular vesicles(EVs)are small vesicles secreted by cells,widely present in various body fluids,and they play important biological roles.In recent years,EVs have garnered significant attention as novel diagnostic and thera-peutic tools in multiple ocular diseases.Glaucoma,as a common cause of irreversible blindness,is primarily caused by optic nerve damage associated with pathologically elevated intraocular pressure.Emerging evidence indicates that EVs hold considerable therapeutic potential in glaucoma management,particularly in modulating aqueous humor circulation and pro-viding retinal neuroprotection.This review summarizes the latest research progress on EVs in the treatment of glaucoma.

Objectives:To explore the predictive value of residual Murray's law-based quantitative flow ratio(μQFR)on long-term vessel-oriented composite endpoints(VoCE).Methods:This retrospective study included 3 510 patients from the FAVOR Ⅲ China trial.Offline residual μQFR analysis was performed on all vessels(diameter≥2.5 mm)with 50%-90%stenotic lesions.Patients were stratified into high-,intermediate-,and low-risk groups based on residual μQFR tertiles.The primary endpoint was 3-year VoCE,defined as a composite of cardiac death related to the target vessel,target vessel-related spontaneous myocardial infarction,and ischemia-driven target vessel revascularization.Results:Offline analysis was performed on 5 256 vessels from 3 510 patients.The mean residual μQFR was 0.92±0.75.The high-risk group(residual μQFR≤0.91)with 1 554 patients(1 958 vessels);the intermediate-risk group(residual μQFR 0.92-0.96)with 1 211 patients(1 906 vessels);and the low-risk group(residual μQFR>0.96)with 745 patients(1 392 vessels).Over 3-year follow-up,VoCE occurred in 227 vessels(4.3%).The 3-year VoCE incidence was significantly higher in the high-risk group compared to the intermediate-and low-risk groups(6.2%vs.4.1%vs.2.5%,log-rank P<0.001),primarily driven by ischemia-driven target vessel revascularization(5.0%vs.3.0%vs.1.6%,log-rank P<0.001).Hypertension(OR=0.83,95%CI:0.72-0.96),hypercholesterolemia(OR=0.84,95%CI:0.73-0.97),bifurcation lesions(OR=0.72,95%CI:0.63-0.83),moderate/severe calcification(OR=0.70,95%CI:0.57-0.84),and tandem lesions(OR=0.59,95%CI:0.47-0.75)were independent predictors of lower residual μQFR values.Conclusions:Lower residual μQFR is significantly associated with increased VoCE risk during the 3-year follow up period.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

To provide scientific guidance and standardization for perioperative clinical nursing practice in patients undergoing percutaneous renal biopsy, relevant evidence on percutaneous renal biopsy nursing care was systematically retrieved and synthesized through an evidence-based approach. After two rounds of Delphi expert consultation and expert panel discussions, expert consensus on perioperative clinical nursing standards for patients undergoing percutaneous renal biopsy (hereinafter referred to as the "Consensus") was developed. The Consensus includes three primary themes: preoperative care, intraoperative care, and postoperative care, encompassing 21 secondary themes. It is characterized by scientific rigor, practical applicability, and comprehensiveness, and serves as a valuable reference and guide for clinical nursing professionals across medical institutions.

Objective This study aimed to explore the correlation between abnormal hand features and coronary atherosclerotic heart disease(CHD)to provide clinical data support for digitalized traditional Chinese medicine(TCM)hand diagnosis.Methods A palm key point prediction algorithm was used to automatically capture and collect detailed features of the palm and nails through image analysis and data mining using the hand diagnosis information collection technology based on the NVIDIA Jetson platform and Qt framework.A total of 438 cardiac patients who underwent coronary artery computed tomography angiography(CACTA)in the Department of Cardiology,Dongzhimen Hospital,Beijing University of Chinese Medicine,from December 2023 to April 2024 were included and divided into CHD(148 cases)and non-CHD groups(290 cases)based on the CACTA results.The hand features of the two groups were compared,and abnormal hand features associated with CHD were screened using random forest analysis as well as univariate and multivariate logistic regression analyses.Results Based on the results of univariate logistic regression and random forest analyses,a set of hand-related features associated with CHD were identified and subsequently included in the multivariate logistic regression analysis.These features included the morphology of the thenar eminence,the wrinkles of the thenar eminence,nail shape,nail texture,and the length of the blood vessel in the middle finger.Multivariate logistic regression analysis revealed that hypertrophic thenar eminence[odds ratio(OR):3.049,95%confidence interval(CI):1.430-6.503,P=0.004],presence of wrinkles on the thenar eminence(OR:2.206,95%CI:1.119-4.348,P=0.022),presence of gray-black vertical stripes on the nails(OR:1.981,95%CI:1.173-3.347,P=0.011),uneven nail surface(OR:3.130,95%CI:1.822-5.378,P<0.001),and inward-bending nail surface(OR:5.727,95%CI:1.812-18.102,P=0.003)were positively associated with CHD.In contrast,the blood vessel in the middle finger longer than 1/3 of the phalanx was negatively associated with CHD(OR:0.405,95%CI:0.234-0.702,P=0.001).Conclusion Certain hand features are significantly associated with CHD,providing the valuable clinical data to support for the digitalization of TCM hand diagnosis.

With the holistic concept of traditional Chinese medicine(TCM)as the foundation,Professor ZHOU Yunfeng proposes the three-part Tuina(Chinese therapeutic massage)manipulation to treat insomnia by"taking the head and brain as the essential and simultaneously regulating the abdomen and back".Taking the theories of Ying-nutrient and Wei-defensive Qi,Zang-Fu organs,and meridians as evidence,this method primarily regulates the mind and concurrently modulates Zang-Fu organs.The three-part Tuina manipulation regulates the spirit by grasping the five meridians(Governor Vessel,Bladder Meridian of Foot Taiyang,and Gallbladder Meridian of Foot Shaoyang)and stimulating points such as Baihui(GV20),Yintang(GV29),Taiyang(EX-HN5),and Shenting(GV24);it regulates the abdomen by selecting Zhongwan(CV12),Shenque(CV8),Qihai(CV6),and Guanyuan(CV4),which means to calm the mind by regulating spleen-stomach Qi activities;it treats the back by selecting Jianjing(GB21),Xinshu(BL15),Pishu(BL20),Weishu(BL21),and Shenshu(BL23),which means to calm the mind by regulating Qi activities of the whole body.Mind regulation runs through the whole process of this manipulation,which combines points from three body regions to produce a synergistic effect,concurrently treating the three body parts,i.e.,the head,abdomen,and back,to mitigate the clinical symptoms and improve sleep quality in insomniacs.