Aromatic inhalation therapy is a key traditional Chinese medicine （TCM） approach for preventing respiratory infectious diseases. Its foundational theory， "aromatics acting on the spleen"， is deeply rooted in TCM principles and supported by modern medical research. The theory posits that the aromatic properties of medicinals primarily act on the spleen， and the aromatic inhalation therapy achieved its protective effects by modulation of the spleen and spleen channel to enhance the regulation of wei qi， striae and interstices. In TCM， the spleen is considered the mother of the lungs， with the function of nurturing lung； it is also seen as the source of wei qi， responsible for external defense； and the root of healthy qi， forming the foundation of acquired （postnatal） constitution. Thus， preventive strategies for respiratory infectious diseases focus on strengthening the spleen. From a modern medical perspective， the spleen's role in regulating lung immune responses， the shared immune functions of the respiratory and gastrointestinal mucosa， and the spleen's overall immune modulation provide scientific evidence for using aromatic inhalation therapy to prevent respiratory infections. Additionally， aromatic inhalation therapy offers several advantages， including direct action， rapid onset， minimal side effects， controllable risks， convenience， and ease of dissemination， making it a practical and effective preventive measure for respiratory infectious diseases.

Aromatic Chinese medicinal essential oils are volatile oils extracted from aromatic Chinese herbs， which can prevent and treat respiratory infectious diseases through multiple synergistic mechanisms including pathogen inhibition， immune regulation， and inflammatory response regulation. Essential oils are primarily used externally on the body to prevent infections and alleviate symptoms through methods like inhalation， smearing， topical application， bathing， gargling or as a suppository. They can also be utilized in the environment for disinfection and air purification， through methods like diffusion， vaporization， or spraying. The external application of essential oils extracted from Chinese aromatic herbs has the advantages of convenience， quick absorption， and simultaneous influence on both the body and mind. However， there are still challenges and deficiencies in aspects such as the positioning of functions， indications， safety， and the research on the mechanism of action. It has been proposed to combine the theory of aromatic Chinese medicinals with the characteristics of essential oils， and formulate prescriptions of Chinese medicinal essential oils under the principles of traditional Chinese medicine syndrome differentiation， and prevent and treat respiratory infectious diseases efficiently， accurately， and safely， thereby expanding the clinical application of aromatic Chinese medicinals and the preventive theory of traditional Chinese medicine.

OBJECTIVE: To investigate the correlation between nucleated red blood cell (NRBC) level on the first day of intensive care unit (ICU) admission and 28-day mortality in adult septic patients, and to evaluate the value of NRBC as an independent predictor of death. METHODS: Single-cell transcriptomic analysis was performed using the GSE167363 dataset from the Gene Expression Omnibus (including 2 healthy controls, 3 surviving septic patients, and 2 non-surviving septic patients). A retrospective clinical analysis was conducted using the America Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, including adult patients (≥ 18 years) with first-time admission who met the Sepsis-3.0 criteria, excluding those without NRBC testing on the first ICU day. The demographic information, vital signs, laboratory test indicators, disease severity score and survival data on the first day of admission were collected. The restricted cubic spline (RCS) curve was used to determine the optimal cut-off value of NRBC for predicting 28-day mortality in patients. Patients were divided into low-risk and high-risk groups based on this cut-off value for intergroup comparison, with Kaplan-Meier survival curve analysis conducted. Independent risk factors for 28-day mortality were analyzed using Logistic regression and Cox regression analysis, followed by the construction of regression models. RESULTS: NRBC were detected in the peripheral blood of septic patients by single-cell transcriptomic. A total of 1 291 sepsis patients were included in the clinical analysis, with 576 deaths within 28 days, corresponding to a 28-day mortality of 44.6%. RCS curve analysis showed a nonlinear relationship between the first-day NRBC level and the 28-day mortality. When NRBC ≥ 1%, the 28-day mortality of patients increased significantly. Compared to the low-risk group (NRBC < 1%), the high-risk group (NRBC ≥ 1%) had significantly higher respiratory rate, heart rate, sequential organ failure assessment (SOFA), and simplified acute physiology score II (SAPSII), and significantly lower hematocrit and platelet count. The high-risk group also had a significantly higher 28-day mortality [49.8% (410/824) vs. 35.5% (166/467), P < 0.05], and shorter median survival time (days: 29.8 vs. 208.6, P < 0.05). Kaplan-Meier survival curve showed that compared with the low-risk group, the survival time of high-risk group was significantly shortened (Log-rank test: χ ² = 25.1, P < 0.001). After adjusting for potential confounding factors including body mass, temperature, heart rate, respiratory rate, mean arterial pressure, serum creatinine, pulse oximetry saturation, hemoglobin, hematocrit, Na⁺, K⁺, platelet count, and SOFA score, multivariate regression analysis confirmed that NRBC ≥ 1% was an independent risk factor for 28-day mortality [Logistic regression: odds ratio (OR) = 1.464, 95% confidence interval (95%CI) was 1.126-1.902, P = 0.004; Cox regression: hazard ratio (HR) = 1.268, 95%CI was 1.050-1.531, P = 0.013]. CONCLUSIONS NRBC ≥ 1% on the first day of ICU admission is an independent risk factor for 28-day mortality in septic patients and can serve as a practical indicator for early prognostic assessment.
Humans ; Sepsis/blood* ; Intensive Care Units ; Risk Factors ; Retrospective Studies ; Prognosis ; Male ; Female ; Hospital Mortality ; Middle Aged ; Aged

Objective To analyze and evaluate the hospital bed efficiency and development trend of 54 tertiary public hospitals in Shandong Province from 2013 to 2020 and to provide a reference for improving efficiency in the use of hospital beds and rationally allocating medical and health resources.Methods Based on the panel data of 54 tertiary public hospitals in Shandong Province from 2013 to 2020,three indicators of bed utilization rate,bed turnover times and the average length of stay of patients were selected to describe the differences of bed use efficiency in each category by using variance analysis and to evaluate the bed use efficiency in tertiary public hospitals in Shandong Province.Results The results of the study show that the bed utilization rate of tertiary public hospitals in Shandong Province decreased from 2013 to 2020,but it is still higher than the national average level.The results of variance analysis showed that in 2019,the overall bed utilization rate of 54 third-level public hospitals reached 95.9%,which was overloaded.The number of bed turnover and the average day of hospitalization were improved,but there were significant differences in bed use efficiency among hospitals with different bed size and institutional attributes(P＜0.05).Conclusion Shandong Province should strengthen the rational allocation of medical resources,improve the level of hospital management,formulate relevant policies to promote the rational use of hospital bed resources,and further improve hospital bed efficiency.

Objective To investigate the effect and mechanism of Bushen Huoxue Prescription(Morindae Officinalis Radix,Cuscutae Semen,Astragali Complanati Semen,Codonopsis Radix,Poria,etc.)on endometrial hyperplasia(EH)rats of kidney deficiency and blood stasis type.Methods A total of 90 SD rats were randomly divided into normal group,model group,Mifepristone group(12 mg·kg-1),and low-,medium-,and high-dose Bushen Huoxue Prescription groups(1.2,2.4,4.8 g·kg-1),with 15 rats in each group.The EH rat model of kidney deficiency and blood stasis type was replicated by intragastric administration of Hydroxyurea and Estradiol Valerate combined with tail vein injection of high molecular dextran.After successful modeling,each group was given intragastric administration according to the set dose,once a day for 21 consecutive days.At the end of the experiment,the levels of serum cyclic adenosine monophosphate(cAMP),cyclic guanosine monophosphate(cGMP),cortisol(CORT),adrenocorticotropic hormone(ACTH),triiodothyronine(T3),thyroxine(T4),thyroid stimulating hormone(TSH),whole blood viscosity,hemorheology and coagulation function were detected by biochemical method.The levels of serum estrogen(E2),follicular estrogen(FSH),luteinizing hormone(LH),nitric oxide(NO)and endothelin-1(ET-1)were detected by ELISA.The pathological changes of endometrial tissue were observed by HE staining,and the endometrial thickness was measured.The protein expression levels of matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1)in endometrial tissues were detected by immunohistochemistry.The protein expression levels of MMP-9,TIMP-1,B-cell lymphoma 2(Bcl-2),Bcl-2 related X protein(Bax)and phosphatase and tensin homologue deleted on chromosome 10(PTEN)in endometrial tissue were detected by Western Blot.Results Compared with the normal group,the levels of serum CORT,ACTH,cAMP,T3,T4,TSH,ET-1 and ET-1/NO ratio in the model group were significantly decreased(P＜0.05,P＜0.01),while the levels of cGMP,E2,FSH,LH and NO were significantly increased(P＜0.05,P＜0.01).The indexes of hemorheology and fibrinogen(FIB)content were significantly increased(P＜0.05),and thrombin time(TT),prothrombin time(PT)and activated partial thromboplastin time(APTT)were significantly prolonged(P＜0.05).The uterine index and endometrial thickness were significantly increased(P＜0.01).The protein expressions of MMP-9 and Bcl-2 in endometrial tissue were significantly up-regulated(P＜0.01),and the protein expressions of TIMP-1,PTEN and Bax were significantly down-regulated(P＜0.01).Compared with the model group,the levels of serum CORT,ACTH,cAMP,T3,T4,TSH,ET-1 and ET-1/NO ratio in the Bushen Huoxue Prescription group were significantly increased(P＜0.05,P＜0.01).The levels of cGMP,E2,FSH,LH and NO were significantly decreased(P＜0.05,P＜0.01).The indexes of hemorheology and FIB content were significantly decreased(P＜0.05,P＜0.01),and TT,PT and APTT were significantly shortened(P＜0.05).The uterine index and endometrial thickness were significantly decreased(P＜0.05,P＜0.01).The protein expressions of MMP-9 and Bcl-2 in endometrial tissue were significantly down-regulated(P＜0.05,P＜0.01),and the protein expressions of TIMP-1,PTEN and Bax were significantly up-regulated(P＜0.05,P＜0.01).Conclusion Bushen Huoxue Prescription can improve the symptoms and signs of EH rats with kidney deficiency and blood stasis,protect endometrial vascular endothelial function,and alleviate endometrial hyperplasia.Its mechanism is related to the restoration of MMP-9/TIMP-1 balance,up-regulation of Bax and PTEN expressions,and inhibition of Bcl-2 expression.

Objective Based on TLR4/NF-κB/MLCK pathway,the therapeutic effect and mechanism of Baihe Dihuang Decoction on insomnia with intestinal flora disturbance in mice induced by p-chlorophenlalanine(PCPA)and multi-factor stimulation were studied.The aim is to provide theoretical basis for clinical use.Methods Eighty-four KM mice were randomly divided into normal group,model group,positive group(Diazepam,1.38 mg·kg-1),Baihe group(2.25 g·kg-1),Dihuang group(2.25 g·kg-1)and Baihe Dihuang Decoction group(4.5 g·kg-1).Insomnia mouse model was established by intraperitoneal injection of PCPA for 2 days combined with 4 weeks of multi-factor stimulation,including stimulating the tail with forceps clip for 2 minutes,reversing day and night for 24 hours,wetting the padding for 24 hours,tilting the cage at 45° for 24 hours,alternating the cages for 24 hours,fasting food for 24 hours,and getting cold bath for 3 minutes,etc.After successfully modeling,corresponding drug treatment was given.The anxiety-like behavior of mice was observed by elevated cross maze system.The latency and duration of sleep were observed by righting reflex experiment.16sRNA sequencing was used to analyze the composition and structure of intestinal flora in mice.The concentration changes of γ-aminobutyric acid(GABA),glutamic acid(Glu),tryptophan(Trp),5-hydroxytryptophan(5-HTP)and 5-hydroxytryptamine(5-HT)in brain and colon were detected by liquid chromatography-mass spectrometry(LC-MS).Immunohistochemical method was used to detect the expressions of zona atresia protein 1(ZO-1)and Occludin in colon.Real-time fluorescence quantitative PCR(qRT-PCR)was used to detect the genes including interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),ZO-1,Occludin,Toll-like receptor 4(TLR4),nuclear factor κB(NF-κB)and myosin light chain kinase(MLCK)in colonic tissue.Western Blot was used to detect the expressions of TLR4,NF-κB,phosphorylated nuclear factor κB(p-NF-κB),MLCK,myosin light chain(MLC)and phosphorylated myosin light chain(p-MLC)in colonic epithelial tissue.Results Compared with the normal group,the distance of entering the open arm and the duration of stay in the open arm of model group in the elevated cross maze were significantly shortened(P＜0.05).The sleep latency was significantly prolonged,and the sleep duration was significantly shortened(P＜0.05).The richness and uniformity of intestinal flora were decreased(P＜0.05,P＜0.01).The concentration of neurotransmitters GABA,Trp,5-HTP and 5-HT in the brain decreased significantly(P＜0.01),while the concentration of Glu increased significantly(P＜0.01).The concentration of GABA and Glu in colon decreased significantly(P＜0.01),while the concentration of Trp,5-HTP and 5-HT increased significantly(P＜0.01).The expression levels of inflammatory factors IL-1β,IL-6 and TNF-α in colonic tissue were significantly increased(P＜0.01),and the expression levels of ZO-1 and Occludin genes and proteins were significantly decreased(P＜0.01).The gene expression levels of TLR4,NF-κB and MLCK were significantly increased(P＜0.01),and the protein expression levels of TLR4,p-NF-κB,MLCK and p-MLC were significantly increased(P＜0.01).Compared with the model group,Baihe Dihuang Decoction could significantly prolong the distance of entering the open arm and the duration of stay in the open arm of insomnia mice in the elevated cross maze(P＜0.05).The sleep latency was significantly shortened,and the sleep duration was significantly increased(P＜0.05).The richness and uniformity of intestinal flora were increased(P＜0.05,P＜0.01).The concentration of neurotransmitters GABA,Trp,5-HTP and 5-HT in brain was increased(P＜0.05,P＜0.01),and the concentration of Glu was decreased(P＜0.01).The concentration of GABA and Glu in colon was increased(P＜0.01),while the concentration of Trp,5-HTP and 5-HT was decreased(P＜0.05,P＜0.01).The expression levels of IL-1β,IL-6 and TNF-α genes were down-regulated(P＜0.01),the expression levels of ZO-1 and Occludin genes and proteins were up-regulated(P＜0.01),TLR4,NF-κB,MLCK gene expression levels and TLR4,p-NF-κB,MLCK,p-MLC protein expression levels were down-regulated in the pathway(P＜0.01).Conclusion Baihe Dihuang Decoction can effectively treat insomnia with intestinal flora disorders.Its mechanism of action may be related to the regulation of brain and intestinal neurotransmitter disorders,down-regulating TLR4/NF-κB/MLCK signaling pathway,and up-regulating tight junction proteins expression,reducing inflammatory responses,and then repairing the mechanical barrier of intestinal mucosa.

Temporal bone CT imaging is particularly important for diagnosis and treatment of ear diseases,but there are some issues such as insufficient resolution,strong artifacts and low signal-to-noise ratio under low radiation doses,which limit its'clinical application.Recent years,deep learning(DL)had shown great potential in classifying,segmenting and reconstructing medical images,providing new ideas for improving imaging quality of temporal bone CT.The application progresses of DL in temporal bone CT imaging were reviewed in this article.

Objective To observe the value of MR lymphangiography(MRL)radiomics for evaluating central conducting lymphatic anomaly(CCLA).Methods Sixty-one patients with complex lymphatic anomaly,including 41 CCLA(group A),20 non-CCLA(generalized lymphatic anomaly and Gorham-Stout disease)and 20 subjects with normal thoracic duct(group B,n=38)were retrospectively enrolled.Cervical and thoracic(combined with abdominal if necessary)MRL was acquired using three-dimensional heavily T2W fast spin echo sequence.ROI was delineated along overall thoracic duct,and radiomics features were extracted.Data sets of group A and B were divided into K subsets using 5-fold cross-validation.The union of(K-1)subset was always used as training set,while the other subsets were used as validation set.Radiomics model was constructed based on support vector machine(SVM)algorithm.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the efficacy of SVM model for assessing CCLA.Results The proportions of bifurcation,cystoid change and extension of main thoracic duct,and extension of terminal thoracic duct in group A were all higher,while of normal main and terminal thoracic duct in group A were both lower than those in group B(all P＜0.05).No significant difference of proportions of multiple thoracic ducts,dextral thoracic duct,part of thoracic duct invisible,multiple terminal thoracic ducts,cystoid change of terminal thoracic duct nor terminal thoracic duct pampiniform was found between groups(all P＞0.05).The sensitivity,specificity,accuracy,positive predictive,negative predictive and AUC of SVM model for evaluating CCLA in training set was 78.95％,97.56％,88.61％,96.77％,83.33％and 0.920,respectively,which in validation set was 78.95％,83.57％,82.28％,83.33％,81.40％and 0.833,respectively.Conclusion MRL radiomics could be used to effectively evaluate CCLA.

Cerebral venous sinus thrombosis(CVST)is a special type of cerebrovascular disease,and the common autoimmune diseases that can cause CVST are systemic lupus erythematosus and antiphospholipid syndrome,and the combination of CVST with Sj?gren's syndrome is not common in clinical practice.The authors reported the case data of a patient with Sj?gren's syndrome combined with CVST and discussed the possible pathogenesis,treatment and prognosis,with the aim of providing some guidance for the diagnosis and treatment of this type of patient.