ObjectiveTo investigate the effect and potential mechanism of caffeic acid （CA） on severe acute pancreatitis （SAP） induced by caerulein combined with lipopolysaccharide （LPS）， and to provide a basis for the research on novel drugs for the treatment of SAP. MethodsC57BL/6J mice， aged 6 weeks， were divided into control group， model group， CA group， and octreotide acetate （OA） group， with 6 mice in each group. The mice in the control group were given injection of normal saline， and those in the other groups were given intraperitoneal injection of caerulein combined with LPS to establish a mouse model of SAP. At 1 hour after the first injection of caerulein， the mice in the CA group and the OA group were given intraperitoneal injection of CA or subcutaneous injection of OA at an interval of 8 hours. The general status of the mice was observed after 24 hours of modeling， and serum， pancreas， lung， and colon samples were collected. HE staining was used to observe the histopathological changes of the pancreas and lungs， and the serum levels of α-amylase， lipase， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， alanine aminotransferase， aspartate aminotransferase， and creatinine were measured. RT-PCR was used to measure the expression of proinflammatory factors in the pancreas and lungs； myeloperoxidase （MPO） immunohistochemistry was used to observe the degree of neutrophil infiltration； Western blot was used to measure the activation of nuclear factor-kappa B （NF-κB） and the level of citrullinated histone H3 （CitH3）， a marker for the formation of neutrophil extracellular traps （NETs）， in the pancreas and lungs， as well as the expression level of ZO-1 in colon tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the Dunnett’s t-test was used for further comparison between two groups. ResultsCompared with the control group， the model group had severe injury in the pancreas and lungs and significant increases in the activity of serum α- amylase and lipase and the levels of the proinflammatory cytokines IL-6， interleukin-1β （IL-1β）， and TNF-α in serum and lung tissue （all P<0.05）， as well as significant increases in NF-κB activation， neutrophil infiltration， and the formation of NETs in the pancreas and lungs （all P<0.05）. Compared with the model group， the CA group had alleviated pathological injury of the pancreas and lungs and significant reductions in the activity of serum α-amylase and the levels of the proinflammatory cytokines IL-6， IL-1β， and TNF-α in serum and lung tissue （all P<0.05）， as well as significant reductions in NF-κB activation， neutrophil infiltration， and the formation of NETs in the pancreas and lungs （all P<0.05）. ConclusionCA can alleviate SAP induced by caerulein combined with LPS in mice， possibly by inhibiting neutrophil recruitment and the formation of NETs.

Objective:To investigate the feasibility and therapeutic effects of a self-designed portable enteral nutrition (EN) kit for home EN in patients with acute pancreatitis (AP) .Methods:A total of 60 patients suffered from moderately severe AP and severe AP and needed home EN in Department of Gastroenterology of First Affiliated Hospital of Naval Medical University between April 2022 and June 2023 were enrolled. They were randomly assigned to portable EN group (observation group, n=28) and routine EN group (control group, n=29) according to random number table. All patients were given EN guidance before discharge. After discharge, all patients were given weekly telephone follow-up to guide the resolution of home EN problems. Patients were followed up from discharge to extubation. The age, gender, body mass index (BMI), disease severity, laboratory indicators (white blood cell, hemoglobin, albumin, total protein), AP related complications before discharge were recorded. During the follow-up period, changes in BMI, laboratory indicators, gastrointestinal symptoms, infection related complications, nutrition tube related complications and Barthel index were recorded. Results:all indicators in the two groups were not significantly statistically different, which comparable at baseline. During the 1-week, 2-week, 3-week and 4-week follow-up period, there was no significant difference on the incidence of infection and complications related to nutrition tube between the two groups, while the incidence of gastrointestinal symptoms in observation group was significantly lower than that in control group and the difference was statistically significant ( P<0.05). At the 3-week and 4-week follow-up, the BMI [ (22.38±3.84) vs (20.38±3.56) kg/m 2; (22.59±3.77) vs (20.54±3.37) kg/m 2], hemoglobin [ (125.00±13.46) vs (113.4±13.64) g/L; (126.20±14.37) vs (114.3±13.25) g/L], and albumin [ (40.96±3.07) vs (39.17±3.31) g/L; (41.79±2.73) vs (39.97±2.67) g/L] levels of the observation group were significantly higher than those of the control group; the living ability score of the observation group was significantly higher than that of the control group (87.32±5.85 vs 82.59±9.79; 89.64±1.31 vs 83.97±8.80) ; and all the differences were statistically significant (all P value <0.05) . Conclusions:The application of portable EN kit can help reduce the gastrointestinal symptoms of AP patients who need long-term home EN, improve nutritional status and life ability.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

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 discuss the regulatory effect of berberine(BBR)on fatty acids in the human glioma T98G cells and its effect on the cell proliferation,migration,and invasion,and to clarify its potential mechanism.Methods:The T98G cells at logarithmic growth phase were divided into control group and different concentrations(25,50,and 100 mg·L-1)of BBR groups.Cell wound healing assay was used to detect the migration rates of the cells in various groups;Transwell chamber assay was used to detect the invasion rates of the cells in various groups.The T98G cells at logarithmic growth phase were divided into control group and 100 mg·L-1 BBR group,and Mass spectrometry was used to detect the fatty acid contents in the cells in two groups.The T98G cells at logarithmic growth phase were divided into control group and different concentrations(50,100,and 150 mg·L-1)of BBR groups;Western blotting method was used to detect the expression levels of phosphatidylinositol 3-kinase(PI3K),phosphorylated PI3K(p-PI3K),protein kinase B(AKT),phosphorylated AKT(p-AKT),sterol regulatory element-binding protein 1(SREBP-1),and fatty acid synthase(FASN)in the cells in various groups.The expression of FASN was suppressed by gene silencing technology,and the T98G cells at logarithmic growth phase were divided into control group,shFASN1 group,and shFASN2 group.Western blotting method was used to detect the expression levels of FASN protein in the cells in various groups;clone formation assay was used to detect the clone formation of the cells in various groups;cell wound healing assay was used to detect the migration rates of the cells in various groups.Results:Compared with control group,the migration rates and invasion rates of the cells in different concentrations of BBR groups were decreased in a concentration-dependent manner(P<0.01),and the fatty acid content in the cells in 100 mg·L-1 BBR group was significantly decreased(P<0.01).Compared with control group,the expression levels of p-PI3K,p-AKT,SREBP-1,and FASN proteins in the cells in 150 mg·L-1 BBR group were significantly decreased(P<0.05 or P<0.01),and the expression level of SREBP-1 protein in the cells in 100 and 150 mg·L-1 BBR groups were significantly decreased(P<0.01).After suppression of FASN expression,compared with control group,the expression levels of FASN protein in the cells in shFASN1 and shFASN2 groups were significantly decreased(P<0.01),and the expression level of FASN protein in the cells in shFASN2 group was lower than that in shFASN1 group(P<0.05);compared with control group,the numbers of clone formation and migration rates of the cells in shFASN1 and shFASN2 groups were significantly decreased(P<0.01),and the migration rate of the cells in shFASN2 group was significantly lower than that in shFASN1 group(P<0.05).Conclusion:BBR interferes with fatty acid synthesis in the glioma T98G cells by reducing the expression of the PI3K/AKT/SREBP-1/FASN pathway related proteins,and decrease their migration and invasion capabilities.

Objective To establish a simultaneous detection approach for 34 emerging contaminants(ECs)in tap water by liquid chromatography-tandem mass spectrometry(HPLC-MS/MS).Human health risk assessment was performed according to the detection results from 43 tap water samples.Methods Tap water samples were concentrated and extracted by solid phase extraction,and then blown to near dry by nitrogen at 40℃.The sample extracts were dissolved in methanol-water solution(95:5,VN)to 0.5 mL for analyzing.Agilent Jet Stream Electrospray Ionization(AJS ESI)and the multiple reaction monitoring(MRM)mode were performed for MS to acquire the data of 34 ECs.A database including precursor ion,product ion and retention times was established accordingly.Results The average linear correlation coefficients(r)of 34 kinds of ECs was 0.995 9.The limits of detection were 0.01～0.60 ng/L and the recoveries were between 60.7％and 119.8％.The intra-group precisions were between 0.05％～9.89％and the intra-day precisions were between 0.20％～14.40％for the spiked samples.The method was applied to analyze 43 tap water samples and a total of 15 ECs were detected.According to the results,the detection rate of caffeine was the highest(84％),and the concentration range was ND～74.42 ng/L.Among all the ECs detected,1,2,3-benzotriazole had the highest concentration(ND～361.15 ng/L),where detection rate was 44％.Humans may be exposed to these ECs by drinking the tap water.The human health risk assessments of 12 kinds of ECs were carried out,however,the estimated risk was negligible(risk quotient＜0.01).Conclusion The method is simple,highly sensitive and selective,and could meet the detection needs of ECs at trace level in tap water.There was no human health risk posed for ECs identified in 43 tap water samples analyzed by this method.

Objective To investigate the effect of the timing of pronase on the quality of magnetically controlled gastric capsule endoscope(MCE).Methods 225 patients from February 2021 to March 2022 were randomly assigned to 3 groups,40 000 u of oral pronase 40 min before examination in Group A,20 000 u of oral pronase for 60 and 40 min before the examination in Group B,20 000 u of oral pronase for 40 and 20 min before examination in Group C.Gastric cavity cleanliness and gastric mucosa visualisation scores(1 to 4)were recorded for the six regions of the stomach and the sum of the scores was calculated.The detection rate of gastric lesions such as gastric polyps and the time of gastric examination were also recorded.Results 221 patients completed the study.In the mucosal visualization score,group C scored(23.56±1.37)points,which was higher than that in group A's(22.56±1.28)points and group B's(23.00±1.33)points.The difference was statistically significant(P<0.05).In the gastric cavity cleanliness score,group C scored(21.44±2.35)points,which was higher than that in group A's(20.11±2.04)points.The difference was statistically significant(P<0.01).In the total score of cleanliness and mucosal visualization score of the proximal stomach(cardia and fundus),group C was higher than group A and group B,and the difference was statistically significant(P<0.05).In the detection rate of lesions,the detection rates of gastric polyps and erosion in group C were 17.8%and 49.3%,respectively,which were higher than group A's(6.8%and 29.7%)and group B's(9.5%and 31.1%).The differences were statistically significant(P<0.05).The gastric observation time in group C was shorter than that in group A and group B,and the difference was statistically significant(P<0.05).Conclusions Oral administration of 20 000 u of pronase in divided doses 40 and 20 min before the examination can enhance the quality of magnetically controlled gastric capsule endoscope.

Objective To compare the performances of 3D MERGE sequence and 3D SPACE STIR sequence in detecting lumbar disc herniation(LDH).Methods The clinical data and MRI data of 135 LDH patients admitted between January 2020 and November 2022 were analyzed retrospectively.All patients were examined using conventional MRI,3D MERGE sequence and 3D SPACE STIR sequence.The consistency of 3D MERGE sequence and 3D SPACE STIR sequence in measuring the diameter of nerve root was analyzed,and the image quality parameters[signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)]and image definition score of the two sequences were evaluated.Results There were no statistically significant differences in L3-S1 nerve root diameters measured by 3D MERGE sequence and 3D SPACE STIR sequence(P＞0.05),and the diameters of L3,L4,L5 and S1 measured by the two sequences showed high correlations(r=0.957,0.986,0.975,0.972,P＜0.05).Compared with 3D SPACE STIR sequence,3D MERGE sequence had higher SNR and CNR,scored better on image definition,and displayed nerve root more clearly(P＜0.05).Conclusion 3D MERGE sequence and 3D SPACE STIR sequence have high consistency in the measurement of LDH nerve root diameter.3D MERGE sequence can display the anatomical morphology of nerve root more clearly as compared with 3D SPACE STIR sequence,and the former one has higher image quality.

Objective:To compare the efficacy of pecto-intercostal fascial plane (PIFP) block versus transversus thoracic muscle plane (TTP) block under ultrasound guidance in coronary artery bypass grafting with general anesthesia.Methods:Ninety American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ patients of either sex, aged 50-79 yr, scheduled for elective coronary artery bypass grafting, were divided into 3 groups ( n=30 each) using a random number table method: PIFP block combined with general anesthesia group (PG group), TTP block combined with general anesthesia group (TG group), and general anesthesia group (G group). After anesthesia induction, bilateral PIFP block was performed under ultrasound guidance in group PG, TTP block was performed under ultrasound guidance in group TG. Three groups used the same general anesthesia method and patient-controlled intravenous analgesia after surgery. Visual analog scale scores (cough, position change, etc) at rest and during activity were recorded at 6, 12, 18 and 24 h after operation. The total consumption of intraoperative sufentanil, extubation time, length of stay in intensive care units, rate of rescue analgesia, effective pressing times of patient-controlled analgesia, incidence of postoperative nausea and vomiting, skin pruritus and nerve block-related adverse events were recorded. The operation time of nerve block was recorded and ultrasound-guided needle visibility score was assessed in PG group and TG group. Results:Compared with group G, the total consumption of intraoperative sufentanil was significantly reduced, the extubation time and length of stay in intensive care units were shortened, visual analog scale scores at rest and during activity were decreased at 6, 12 and 18 h after operation, the rate of rescue analgesia was decreased, and the effective pressing times of patient-controlled analgesia were decreased in group PG and group TG ( P<0.05), and no significant change was found in the aforementioned parameters in PG and TG groups ( P> 0.05). Compared with group TG, the operational time of nerve block was significantly shortened, and the ultrasound-guided needle visibility score was increased in group PG ( P<0.05). No nerve block-related adverse events were found in PG and TG groups. There was no significant difference in the incidence of postoperative nausea and vomiting and skin pruritus among the three groups ( P>0.05). Conclusions:PIFP block can provide good perioperative analgesia and promote the rapid recovery in the patients undergoing coronary artery bypass grafting with general anesthesia. Although the analgesic effect of PIFP blockade is similar to that of TTP blockade, PIFP blockade is more clinically valuable due to its simpler operation and less relative risk.

OBJECTIVE To establish an ion chromatography method for the simultaneous determination of chloride， sulfate and bicarbonate ions in Polyethylene glycol electrolyte powder （Ⅲ）. METHODS The chromatographic column was a Dionex IonpacTM AS11-HC anion analysis column， with a Dionex IonPacTM AG11-HC guard column. The mobile phase was 10 mmol/L potassium hydroxide at an isocratic elution flow rate of 1.2 mL/min. The detector was a conductivity detector， and the suppressor was a Dionex AERS with a suppressor current of 30 mA. The column temperature was maintained at 30 ° C， and the injection volume was 10 μL. Chloride and sulfate contents were calculated by external standard method， while bicarbonate content was determined by double logarithmic fitting standard curve method. RESULTS Under these chromatographic conditions， chloride， sulfate and bicarbonate ions were effectively separated with linear ranges of 0.055 to 0.219 mg/mL （r＝0.999 9）， 0.155 to 0.618 mg/mL （r＝1.000 0）， and 0.065 to 0.121 mg/mL （r＝0.999 9）， respectively. The recoveries were 98.06% to 101.34%， 97.37% to 101.25%， and 97.16% to 99.81%， respectively， with RSDs of 1.1%， 1.3% and 1.0% （n＝9）. The RSDs for the evaluation of precision， accuracy， stability and ruggedness were all less than 2%. CONCLUSIONS The established ion chromatography is simple， rapid， accurate， precise and durable， can simultaneously determine the contents of chloride， sulfate and bicarbonate ions in Polyethylene glycol electrolyte powder （Ⅲ）， which is suitable for its quality control.