ObjectiveTo observe the clinical efficacy of tonifying kidney and replenishing essence on asthenozoospermia patients with the syndrome of kidney essence deficiency and the effects of this method on the adenosine 5′-monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin complex 1 （mTORC1） signaling pathway. MethodsSeventy-two eligible asthenozoospermia patients with the syndrome of kidney essence deficiency treated in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from February 2023 to January 2024 were selected and randomly assigned into an observation group and a control group， with 36 patients in each group. The observation group received oral administration of Guilu Tianjing capsules， while the control group received oral administration of L-carnitine oral solution. The treatment course lasted for 4 weeks in both groups. The observed indicators included sperm progressive motility rate （PR）， total sperm motility （PR+NP）， percentage of normal mitochondrial membrane potential （MMP）， and traditional Chinese medicine （TCM） symptom scores before and after treatment in both groups. A three-month follow-up was instituted to record the conception status of the patients’ spouses. Additionally， eight patients were randomly selected from the eligible patients in the observation group， and four healthy males with normal semen routine examination results were included as the control group for the determination of protein expression. Western blotting was conducted to assess the expression of AMPK， phosphorylated （p）-AMPK， regulatory-associated protein of mTOR （RAPTOR） and p-RAPTOR， and PTEN-induced putative kinase 1 （PINK1） in sperms from the observation group before and after treatment， as well as in the sperms of the control group. ResultsThe pregnancy rate of spouses in the observation group was 9.09% （3/33）， which was higher than that （3.33%， 1/30） in the control group. The total response rate was 84.8% （28/33） in the observation group and 66.7% （20/30） in the control group， with no statistically significant difference. After treatment， both groups were improved considering PR， PR+NP， MMP， and TCM symptom scores （P<0.01）. Moreover， the observation group exhibited more pronounced decreases in TCM symptom scores than the control group （P<0.05）， while the changes in PR， PR+NP， and MMP showed no statistical significance between groups. Compared with the control group， the asthenozoospermia group exhibited upregulations in phosphorylation levels of AMPK and RAPTOR and protein level of PINK （P<0.01）. The administration of Guilu Tianjing Capsules led to downregulations in the phosphorylation levels of AMPK and RAPTOR and protein level of PINK1 （P<0.01）. However， the protein levels of AMPK and RAPTOR demonstrated no significant difference between before and after treatment. During the study period， neither group of patients exhibited any notable adverse reactions. ConclusionGuilu Tianjing capsules can enhance the sperm motility and percentage of normal mitochondrial membrane potential in asthenozoospermia patients with the syndrome of kidney essence deficiency by downregulating the AMPK/mTORC1 signaling pathway， lowering the protein level of PINK1， and inhibiting excessive activation of mitophagy.

ObjectiveTo observe the clinical efficacy of tonifying kidney and replenishing essence on asthenozoospermia patients with the syndrome of kidney essence deficiency and the effects of this method on the adenosine 5′-monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin complex 1 （mTORC1） signaling pathway. MethodsSeventy-two eligible asthenozoospermia patients with the syndrome of kidney essence deficiency treated in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from February 2023 to January 2024 were selected and randomly assigned into an observation group and a control group， with 36 patients in each group. The observation group received oral administration of Guilu Tianjing capsules， while the control group received oral administration of L-carnitine oral solution. The treatment course lasted for 4 weeks in both groups. The observed indicators included sperm progressive motility rate （PR）， total sperm motility （PR+NP）， percentage of normal mitochondrial membrane potential （MMP）， and traditional Chinese medicine （TCM） symptom scores before and after treatment in both groups. A three-month follow-up was instituted to record the conception status of the patients’ spouses. Additionally， eight patients were randomly selected from the eligible patients in the observation group， and four healthy males with normal semen routine examination results were included as the control group for the determination of protein expression. Western blotting was conducted to assess the expression of AMPK， phosphorylated （p）-AMPK， regulatory-associated protein of mTOR （RAPTOR） and p-RAPTOR， and PTEN-induced putative kinase 1 （PINK1） in sperms from the observation group before and after treatment， as well as in the sperms of the control group. ResultsThe pregnancy rate of spouses in the observation group was 9.09% （3/33）， which was higher than that （3.33%， 1/30） in the control group. The total response rate was 84.8% （28/33） in the observation group and 66.7% （20/30） in the control group， with no statistically significant difference. After treatment， both groups were improved considering PR， PR+NP， MMP， and TCM symptom scores （P<0.01）. Moreover， the observation group exhibited more pronounced decreases in TCM symptom scores than the control group （P<0.05）， while the changes in PR， PR+NP， and MMP showed no statistical significance between groups. Compared with the control group， the asthenozoospermia group exhibited upregulations in phosphorylation levels of AMPK and RAPTOR and protein level of PINK （P<0.01）. The administration of Guilu Tianjing Capsules led to downregulations in the phosphorylation levels of AMPK and RAPTOR and protein level of PINK1 （P<0.01）. However， the protein levels of AMPK and RAPTOR demonstrated no significant difference between before and after treatment. During the study period， neither group of patients exhibited any notable adverse reactions. ConclusionGuilu Tianjing capsules can enhance the sperm motility and percentage of normal mitochondrial membrane potential in asthenozoospermia patients with the syndrome of kidney essence deficiency by downregulating the AMPK/mTORC1 signaling pathway， lowering the protein level of PINK1， and inhibiting excessive activation of mitophagy.

BACKGROUND:Pyroptosis,as a unique form of inflammatory cell death,plays an important role in the instability of atherosclerotic lesions.OBJECTIVE:To explore the action mechanism of recombinant B-cell lymphoma 2-related protein A1(BCL2A1)in atherosclerosis.METHODS:(1)Human umbilical vein endothelial cells were treated with 200 μg/mL oxidized low-density lipoprotein for 24 hours to induce endothelial injury.Subsequently,50 nmol/L BCL2A1 interfering plasmid(BCL2A1 short hairpin RNA,sh-BCL2A1)and 1.5 μg/mL histone deacetylase 1 gene(HDAC1)overexpression vector(pcDNA-HDAC1)was transfected into human umbilical vein endothelial cells,or both pcDNA-HDAC1 and BCL2A1 overexpression vector(pcDNA-BCL2A1)were transfected simultaneously.After 48 hours of cell culture,the expression levels of BCL2A1 and HDAC1,cell viability,cell pyroptosis level,and BCL2A1 acetylation level were detected.(2)The atherosclerosis mouse model was constructed by high-fat feeding APOE-/-mouse for in vivo verification.500 μL of BCL2A1 and HDAC1 lentiviral overexpression vectors were injected into mice via tail vein,respectively or simultaneously.The expression levels of BCL2A1 and HDAC1 and the damage of arterial tissue in mice were detected.RESULTS AND CONCLUSION:The expression of BCL2A1 was upregulated in human umbilical vein endothelial cells induced by oxidized low-density lipoprotein.Interference of BCL2A1 improved cell viability and inhibited pyroptosis and inflammatory response.In addition,HDAC1 was down-regulated in oxidized low-density lipoprotein-induced human umbilical vein endothelial cells.Cell viability was elevated and pyroptosis and inflammatory response were inhibited by promoting BCL2A1 deacetylation.In vivo experiments showed that BCL2A1 was highly expressed in arterial tissues of mice fed with high-fat diet,while HDAC1 was lowly expressed.Additionally,HDAC1 alleviated high-fat diet-induced arterial tissue lesions in ApoE-/-mice by promoting the deacetylation of BCL2A1.It is concluded that HDAC1 may inhibit pyroptosis of human umbilical vein endothelial cells by deacetylating BCL2A1 to reduce atherosclerosis and inflammatory response.

Against the backdrop of high-quality development in public hospitals,scientific post establishment and staffing are key to optimizing human resource allocation and enhancing operational efficiency.Taking Shenzhen Yantian District People's Hospital(Group)as an example,this paper addresses issues such as unclear job responsibilities and imbalanced personnel struc-ture by systematically implementing post establishment and staffing practices through third-party cooperation.Utilizing multiple methods including efficiency-based staffing,scheduling-based staffing,and ratio-based staffing,combined with workload meas-urement and a dynamic adjustment mechanism,precise allocation for clinical,medical technical,and administrative posts was a-chieved.Results showed a reduction of 46 redundant personnel hospital-wide,the proportion of administrative staff decreased to 15％,the doctor-to-nurse ratio met national standards,the overall bed-to-nurse ratio reached 1∶0.8,and labor costs were signif-icantly optimized.The study indicates that post establishment and staffing must be based on actual workload,dynamically adjus-ted in line with hospital strategy,and require hospital-wide collaborative promotion.This research provides a practical pathway worthy of reference for human resource management in public hospitals.

Against the backdrop of high-quality development in public hospitals,scientific post establishment and staffing are key to optimizing human resource allocation and enhancing operational efficiency.Taking Shenzhen Yantian District People's Hospital(Group)as an example,this paper addresses issues such as unclear job responsibilities and imbalanced personnel struc-ture by systematically implementing post establishment and staffing practices through third-party cooperation.Utilizing multiple methods including efficiency-based staffing,scheduling-based staffing,and ratio-based staffing,combined with workload meas-urement and a dynamic adjustment mechanism,precise allocation for clinical,medical technical,and administrative posts was a-chieved.Results showed a reduction of 46 redundant personnel hospital-wide,the proportion of administrative staff decreased to 15％,the doctor-to-nurse ratio met national standards,the overall bed-to-nurse ratio reached 1∶0.8,and labor costs were signif-icantly optimized.The study indicates that post establishment and staffing must be based on actual workload,dynamically adjus-ted in line with hospital strategy,and require hospital-wide collaborative promotion.This research provides a practical pathway worthy of reference for human resource management in public hospitals.

BACKGROUND:Pyroptosis,as a unique form of inflammatory cell death,plays an important role in the instability of atherosclerotic lesions.OBJECTIVE:To explore the action mechanism of recombinant B-cell lymphoma 2-related protein A1(BCL2A1)in atherosclerosis.METHODS:(1)Human umbilical vein endothelial cells were treated with 200 μg/mL oxidized low-density lipoprotein for 24 hours to induce endothelial injury.Subsequently,50 nmol/L BCL2A1 interfering plasmid(BCL2A1 short hairpin RNA,sh-BCL2A1)and 1.5 μg/mL histone deacetylase 1 gene(HDAC1)overexpression vector(pcDNA-HDAC1)was transfected into human umbilical vein endothelial cells,or both pcDNA-HDAC1 and BCL2A1 overexpression vector(pcDNA-BCL2A1)were transfected simultaneously.After 48 hours of cell culture,the expression levels of BCL2A1 and HDAC1,cell viability,cell pyroptosis level,and BCL2A1 acetylation level were detected.(2)The atherosclerosis mouse model was constructed by high-fat feeding APOE-/-mouse for in vivo verification.500 μL of BCL2A1 and HDAC1 lentiviral overexpression vectors were injected into mice via tail vein,respectively or simultaneously.The expression levels of BCL2A1 and HDAC1 and the damage of arterial tissue in mice were detected.RESULTS AND CONCLUSION:The expression of BCL2A1 was upregulated in human umbilical vein endothelial cells induced by oxidized low-density lipoprotein.Interference of BCL2A1 improved cell viability and inhibited pyroptosis and inflammatory response.In addition,HDAC1 was down-regulated in oxidized low-density lipoprotein-induced human umbilical vein endothelial cells.Cell viability was elevated and pyroptosis and inflammatory response were inhibited by promoting BCL2A1 deacetylation.In vivo experiments showed that BCL2A1 was highly expressed in arterial tissues of mice fed with high-fat diet,while HDAC1 was lowly expressed.Additionally,HDAC1 alleviated high-fat diet-induced arterial tissue lesions in ApoE-/-mice by promoting the deacetylation of BCL2A1.It is concluded that HDAC1 may inhibit pyroptosis of human umbilical vein endothelial cells by deacetylating BCL2A1 to reduce atherosclerosis and inflammatory response.

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.

Objective To explore the value of combined detection of serum pyruvate dehydrogenase kinase isoenzyme 4(PDK4),2,4-dienoyl coenzyme A reductase 1(DECR1)and matrix metalloproteinase 1(MMP1)in the diagnosis,clinical grading and prognosis of diabetes cardiomyopathy(DCM).Methods A sum of 26 patients with diabetes cardiomyopathy(DCM group)and 120 patients with diabetes non cardiomyopathy(control group)who were admitted to Shaanxi Provincial People's Hospital from October 2021 to October 2023 were selected.The expression levels of PDK4,DECR1 and MMP1 proteins in serum were measured by enzyme-linked immunosorbent assay(ELISA)to evaluate the diagnostic value of these three detection indicators in DCM.Results Compared with the Control group,the levels of serum PDK4(131.38±10.20 pg/ml vs 82.69±8.17 pg/ml),DECR1(152.06±12.57 pg/ml vs 86.14±9.55 pg/ml)and MMP1(40.27±4.02 μg/ml vs 17.77±0.98 μg/ml)protein in the diabetes cardiomyopathy(DCM)group were significantly higher,and the differences were statistically significant(t=36.24,47.63,12.29,all P＜0.001).In the DCM group,the protein expression levels of serum PDK4,DECR1 and MMP1 were correlated with NYHA cardiac function grading,while the protein expression levels were significantly increased with the grade increasing,and the differences between the groups were statistically significant(F=24.12,30.04,12.66,all P＜0.001).In the DCM group,compared with the mild group,the expression levels of serum PDK4(164.92±1.35pg/ml vs 122.48±8.78pg/ml),DECR1(192.17±9.11pg/ml vs 124.36±10.83pg/ml)and MMP1(84.44±7.38 μg/ml vs 39.41±3.05 μ g/ml)proteins were significantly increased in patients with moderate to severe illness,and the differences were statistically significant(t=26.33,47.12,15.41,all P＜0.001).The accuracy(x2=18.23,21.37,22.07),specificity(x2=9.72,13.43,15.12)and sensitivity(x2=12.07,16.07,17.55)of serum PDK4,DECR1 and MMP1 were significantly higher than those of single Test(all P＜0.05),the results of ROC curve analysis showed that the AUC of combined detection was 0.955,which was significantly higher than that of single detection(Z=16.67,17.09,20.44,all P＜0.05).Conclusion Serum PDK4,DECR1 and MMP1 are related to the diagnosis,clinical grading and prognosis of diabetes cardiomyopathy.The combined detection of the three is helpful to the differential diagnosis of diabetes cardiomyopathy.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective: To investigate the effect of salidroside(Sal) on ischemia reperfusion(IR) in isolated rat heart and explore the underlying mechanisms on endoplasmic reticulum stress(ERS) and apoptosis. Methods: The isolated rat hearts underwent Langendorff perfusion subjected to IR. After ischemia for 45 min and reperfusion for 2 h, the isolated rat hearts were randomly divided into four groups(n=10): Control group, Sal treatment group(Sal), ischemia reperfusion group(IR) and Sal treatment with ischemia reperfusion group(IR+Sal). Myocardial infarct size was detected by TTC staining. Lactate dehydrogenase(LDH) activity in the coronary flow was determined by ELISA. The cardiac function was evaluated by left ventricular peak systolic pressure(LVSP) and left ventricular end diastolic pressure(LVEDP). The expressions of B-cell lymphoma-2(Bcl-2), Bcl-2-associated X(Bax),protein kinase R-like endoplasmic reticulum kinase(PERK), C/EBP homologous protein(CHOP) and activating transcription factor 6(ATF6) were detected by Western blot, and apoptosis was observed by TUNEL staining. Results: There was no significant difference in all indexes between Sal group and Control group. Compared with Control group, the infarct size and LDH activity in the coronary flow increased in IR group. The LVSP value decreased, and the LVEDP value increased. The expression of Bax and the TUNEL-positive cells increased, while the expression of Bcl-2 decreased. Meanwhile, the expressions of ERS related proteins including PERK, CHOP and ATF6 also increased. Compared with IR group, the infarct size and LDH activity in the coronary flow increased in IR+Sal group. The LVSP value increased, and the LVEDP value decreased. The expression of Bax and the TUNEL-positive cells decreased, while the expression of Bcl-2 increased. In addition, the expressions of PERK, CHOP and ATF6 decreased. Conclusion Sal can improve myocardial IR injury by inhibiting ERS and apoptosis in isolated rat hearts.