Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

This study was aimed at understanding the trends in,and scope of,severe fever with thrombocytopenia syndrome(SFTS)in Nanjing,analyzing the spatial distribution pattern,detecting high incidence cluster areas and key popula-tions,and scientifically guiding prevention and control strategies and measures.We obtained data on SFTS cases from 2010 to 2023 in Nanjing from the China Disease Control and Prevention Information System,and described the time,popu-lation,and spatial distribution characteristics.We used joinpoint regression to calculate the annual percentage change(APC)in incidence,then used FleXScan spatial clustering scan analysis to explore spatial clustering areas at the street level.A total of 507 SFTS cases were reported from 2010 to 2023 in Nanjing.The APC was 31.8％(95％CI:22.5％-41.9％,P＜0.001),and the reported incidence in 2023 was 1.42/100 000(134 cases).The seasonal indices from May to August were 2.7,2.1,3.0,and 1.3,respectively,accounting for 76.1％of the total cases.The median age was 66(IQR:55,73)years,which gradually increased from 59 years in 2010-2011 to 68 in 2022-2023(P＜0.001);94.1％of cases were in individuals 45 years or older.Farmers,homemakers/unemployed individuals,and retirees accounted for 90.1％.The epidemic area increased from 11 streets in four districts in 2010-2011 to 58 streets in 11 dis-tricts in 2022-2023.Except for 2012-2013,global spatial autocorrelation analysis showed positive Moran's I values(0.224-0.526,P＜0.001),and FlexScan scan indicated that several streets in Lishui District and Jiangning District were the most likely clusters.Four streets in Pukou District were the secondary clusters from 2018 to 2023,and three streets in Luhe District in 2022-2023 were the secondary clusters(all P＜0.05).The reported incidence of SFTS in Nanjing showed a rapid upward trend,with spread of epidemic areas.The spatial distribution pattern was clustered.Strengthened training in diagnosis and treatment technology and detection ability of medical institutions,surveillance in high-incidence areas,tracing of case flow,and health education of tick and disease prevention knowledge are recommended.

Objective:To evaluate the risk factors for the formation of parastomal Hernias(PSH)using meta-analysis,and to provide a theoretical basis for the prevention and treatment of PSH.Methods:Case control or Cohort study of PSH risk factors were collected by searching PubMed,CNKI,Wanfang data and other databases.Extract relevant data and perform meta-analysis using RevMan 5.3.Results:The results included a total of 16 studies,with a total sample size of 2411 cases,including 670 in the PSH group and 1741 in the non PSH group.The results showed that advanced age,female gender,BMI≥25,hypertension,COPD/chronic cough,diabetes,and postoperative Hypoproteinemia could increase the risk of PSH(P＜0.05);Smoking,previous ab-dominal surgery history,preoperative radiotherapy/chemotherapy etc.,were not significantly asso-ciated with the occurrence of PSH(P＞0.05).Conclusion:The current evidence shows that ad-vanced age,female gender,BMI≥25,hypertension,COPD/chronic cough,diabetes,postoperative Hypoproteinemia are risk factors for PSH,and extraperitoneal stoma can reduce the occurrence of PSH.

Transcranial electrical stimulation (tES) is a non-invasive neural modulation technique known for its high safety, patient compliance, and portability. It holds promise as a potential non-pharmacological method for analgesia. However, challenges persist in utilizing tES for pain management, including inconsistent research findings and limited understanding of its analgesic mechanisms. Therefore, by summarizing the advances in the analgesic researches employing the 3 primary tES techniques, transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and transcranial random noise stimulation (tRNS), we reviewed the analgesic effects on both acute and chronic pain, as well as the neural mechanisms underlying the analgesic effect of each technique. Accumulating evidence suggests that the analgesic effects of tDCS are significant, but studies on analgesic effects of tACS and tRNS remain limited. And the exact mechanisms of pain relief through tES turned out to be not yet well established. Furthermore, we systematically discussed the limitations of analgesia-related studies employing tES techniques across various aspects, involving research design, stimulation protocol formulation, neural response observation, analgesic effect assessment, and safety considerations. To address these limitations and advance clinical translation, we emphasized utilizing promising stimulation techniques and offered practical suggestions for future research endeavors. Specifically, employing numerical simulation of electric field guided by magnetic resonance imaging (MRI) would reduce variability of outcomes due to individual differences in head anatomy. For this purpose, it is advisable to establish standardized head models based on MRI data from the Chinese populations and validate simulated electric field results in tES research to diminish confounding factors concerning anatomy. Meanwhile, novel techniques like multi-site brain stimulation and interferential stimulation (IFS) could broaden the range of stimulation sites in both scope and depth. Multi-site brain stimulation facilitates modulation of entire neural networks, enabling more sophisticated investigations into the complexity of pain. IFS can reach deep brain tissues without invasive surgical procedures, achieving more comprehensive modulation. Regarding neural response observations, establishing a tES-neuroimaging synchronized platform would enable revealing its mechanisms and personalizing protocols based on inter-subject neural response variability detected through recordings. By integrating tES with various neuroimaging techniques, such as functional MRI, electroencephalography (EEG) and magnetoencephalography, into one unified platform, researchers could examine brain activities in baseline before stimulation, dynamic changes in brain activities during stimulation, and sustained brain responses after stimulation. Additionally, collecting finer-grained data on participant characteristics and pain intensity would enhance the sensitivity of future studies. In designing clinical trials to evaluate chronic pain treatments and reporting the results, adopting the six core outcome domain measures recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) could prove beneficial. Lastly, safety considerations can never be overemphasized in future tES studies especially when combining tES with MRI and EEG techniques. These efforts may help to broaden the research scope, reconcile inconsistencies in findings and elucidate the analgesic mechanisms of tES, thus facilitating the development of pragmatic pain management strategies such as combination therapies and home therapies. Ultimately, these suggestions will maximize the clinical application value of tES in pain treatment to achieve pain relief for patients.

Objective:To investigate the correlation between serum Chemerin and nerve growth associated protein (GAP) -43 levels and hyperhomocysteinemia (HHcy) in acute ischemic stroke.Methods:The clinical data of 149 patients with acute ischemic stroke admitted to the Sun Simiao Hospital of Beijing University of Traditional Chinese Medicine from March 2021 to May 2023 were retrospectively analyzed, and the patients were divided into observation group (97 cases) and control group (52 cases) according to whether they were combined with HHcy. Observation group patients were divided into mild group ( n=29), moderate group ( n=38) and severe group ( n=30) according to the severity of the disease. The serum Chemerin and GAP-43 levels of the observation group and the control group were compared, and the serum Chemerin and GAP-43 levels of the observation group with different severity of disease were compared, and the correlation between the serum Chemerin and GAP-43 levels and the severity of acute ischemic stroke patients with HHcy was analyzed. The influencing factors of poor prognosis in patients with acute ischemic stroke complicated with HHcy were analyzed, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of serum Chemerin and GAP-43 for poor prognosis in patients with acute ischemic stroke complicated with HHcy. Results:The levels of Chemerin and GAP-43 in the observation group were higher than those in the control group (all P<0.05). Serum Chemerin and GAP-43 levels in the severe group were higher than those in the mild group and the moderate group (all P<0.05), and serum Chemerin and GAP-43 levels in the moderate group were higher than those in the mild group (all P<0.05). Pearson correlation analysis showed that serum Chemerin and GAP-3 levels were positively correlated with the severity of acute ischemic stroke patients with HHcy ( r=0.458, 0.497, all P<0.05). Among 97 patients with acute ischemic stroke complicated with HHcy, 19 had poor prognosis and 78 had good prognosis. In the poor prognosis group, the proportion of diabetes, the severity of the disease and the levels of blood glucose, C-reactive protein (CRP), vascular endothelial growth factor (VEGF) and malondialdehyde (MDA) were higher than those in the good prognosis group (all P<0.05), and the superoxide dismutase (SOD) was lower than those in the good prognosis group ( P<0.05). Logistic regression analysis showed that the severity of the disease, CRP, Chemerin and GAP-43 were the influential factors for the poor prognosis of acute ischemic stroke patients with HHcy (all P<0.05). ROC curve results showed that the area under the curve (AUC) of serum Chemerin and GAP-43 levels and their combination in predicting poor prognosis of acute ischemic stroke patients with HHcy were 0.799, 0.804 and 0.907, respectively, and the AUC of the combination was larger ( P<0.05). Conclusions:Serum Chemerin and GAP-43 levels are closely related to the severity and prognosis of acute ischemic stroke patients with HHcy, and their combined value is higher in predicting poor prognosis.

Objective:To investigate the correlation between serum Chemerin and nerve growth associated protein (GAP) -43 levels and hyperhomocysteinemia (HHcy) in acute ischemic stroke.Methods:The clinical data of 149 patients with acute ischemic stroke admitted to the Sun Simiao Hospital of Beijing University of Traditional Chinese Medicine from March 2021 to May 2023 were retrospectively analyzed, and the patients were divided into observation group (97 cases) and control group (52 cases) according to whether they were combined with HHcy. Observation group patients were divided into mild group ( n=29), moderate group ( n=38) and severe group ( n=30) according to the severity of the disease. The serum Chemerin and GAP-43 levels of the observation group and the control group were compared, and the serum Chemerin and GAP-43 levels of the observation group with different severity of disease were compared, and the correlation between the serum Chemerin and GAP-43 levels and the severity of acute ischemic stroke patients with HHcy was analyzed. The influencing factors of poor prognosis in patients with acute ischemic stroke complicated with HHcy were analyzed, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of serum Chemerin and GAP-43 for poor prognosis in patients with acute ischemic stroke complicated with HHcy. Results:The levels of Chemerin and GAP-43 in the observation group were higher than those in the control group (all P<0.05). Serum Chemerin and GAP-43 levels in the severe group were higher than those in the mild group and the moderate group (all P<0.05), and serum Chemerin and GAP-43 levels in the moderate group were higher than those in the mild group (all P<0.05). Pearson correlation analysis showed that serum Chemerin and GAP-3 levels were positively correlated with the severity of acute ischemic stroke patients with HHcy ( r=0.458, 0.497, all P<0.05). Among 97 patients with acute ischemic stroke complicated with HHcy, 19 had poor prognosis and 78 had good prognosis. In the poor prognosis group, the proportion of diabetes, the severity of the disease and the levels of blood glucose, C-reactive protein (CRP), vascular endothelial growth factor (VEGF) and malondialdehyde (MDA) were higher than those in the good prognosis group (all P<0.05), and the superoxide dismutase (SOD) was lower than those in the good prognosis group ( P<0.05). Logistic regression analysis showed that the severity of the disease, CRP, Chemerin and GAP-43 were the influential factors for the poor prognosis of acute ischemic stroke patients with HHcy (all P<0.05). ROC curve results showed that the area under the curve (AUC) of serum Chemerin and GAP-43 levels and their combination in predicting poor prognosis of acute ischemic stroke patients with HHcy were 0.799, 0.804 and 0.907, respectively, and the AUC of the combination was larger ( P<0.05). Conclusions:Serum Chemerin and GAP-43 levels are closely related to the severity and prognosis of acute ischemic stroke patients with HHcy, and their combined value is higher in predicting poor prognosis.

This study aims to explore the neuroprotective effect of bilobalide(BB) and the mechanisms such as inhibiting inflammatory response in macrophage/microglia, promoting neurotrophic factor secretion, and interfering with the activation and differentiation of peripheral CD4~+ T cells. BB of different concentration(12.5, 25, 50, 100 μg·mL~(-1)) was used to treat the RAW264.7 and BV2 cells for 24 h. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay and cell counting kit-8(CCK-8) were employed to detect the cytotoxicity of BB and appropriate concentration was selected for further experiment. Lipopolysaccharide(LPS) was applied to elicit inflammation in RAW264.7 and BV2 cells, mouse bone marrow-derived macrophages(BMDMs), and primary microglia, respectively. The effect of BB on cell proliferation and secretion of inflammatory cytokines and neurotrophic factors was detected by enzyme-linked immunosorbent assay(ELISA). Spleen monocytes of C57BL/6 female mice(7-8 weeks old) were isolated, and CD4~+ T cells were separated by magnetic beads under sterile conditions. Th17 cells were induced by CD3/CD28 and the conditioned medium for eliciting the inflammation in BMDMs. The content of IL-17 cytokines in the supernatant was detected by ELISA to determine the effect on the activation and differentiation of CD4~+ T cells. In addition, PC12 cells were incubated with the conditioned medium for eliciting inflammation in BMDMs and primary microglia and the count and morphology of cells were observed. The cytoto-xicity was determined by lactate dehydrogenase(LDH) assay. The result showed that BB with the concentration of 12.5-100 μg·mL~(-1) had no toxicity to RAW264.7 and BV2 cells, and had no significant effect on the activity of cell model with low inflammation. The 50 μg·mL~(-1) BB was selected for further experiment, and the results indicated that BB inhibited LPS-induced secretion of inflammatory cytokines. The experiment on CD4~+ T cells showed that the conditioned medium for LPS-induced inflammation in BMDMs promoted the activation and differentiation of CD4~+ T cells, while the conditioned medium of the experimental group with BB intervention reduced the activation and differentiation of CD4~+ T cells. In addition, BB also enhanced the release of neurotrophic factors from BMDMs and primary microglia. The conditioned medium after BB intervention can significantly reduce the death of PC12 neurons, inhibit neuronal damage, and protect neurons. To sum up, BB plays a neuroprotective role by inhibiting macrophage and microglia-mediated inflammatory response and promoting neurotrophic factors.
Female ; Rats ; Mice ; Animals ; Bilobalides/pharmacology* ; Neuroprotection ; Lipopolysaccharides/toxicity* ; Culture Media, Conditioned/pharmacology* ; Mice, Inbred C57BL ; Macrophages/metabolism* ; Microglia ; Cytokines/metabolism* ; Nerve Growth Factors/pharmacology* ; Inflammation/metabolism*

The modernization and development of traditional Chinese medicine has led to higher standards for the quality of traditional Chinese medicine products. The extraction process is a crucial component of traditional Chinese medicine production, and it directly impacts the final quality of the product. However, the currently relied upon methods for quality assurance of the extraction process, such as simple wet chemical analysis, have several limitations, including time consumption and labor intensity, and do not offer precise control of the extraction process. As a result, there is significant value in incorporating near-infrared spectroscopy (NIRS) in the production process of traditional Chinese medicine to improve the quality control of the final products. In this study, we focused on the extraction process of Xiao'er Xiaoji Zhike oral liquid (XXZOL), using near-infrared spectra collected by both a Fourier transform near-infrared spectrometer and a portable near-infrared spectrometer. We used the concentration of synephrine, a quality control index component specified by the pharmacopoeia, to achieve rapid and accurate detection in the extraction process. Moreover, we developed a model transfer method to facilitate the transfer of models between the two types of near-infrared spectrometers (analytical grade and portable), thus resolving the low resolution, poor performance, and insufficient prediction accuracy issues of portable instruments. Our findings enable the rapid screening and quality analysis of XXZOL onsite, which is significant for quality monitoring during the traditional Chinese medicine production process.