Objective:To investigate whether herb cake-insulated moxibustion affects the expression of cholesterol metabolism-related protein 3-hydroxy-3-methylglutaryl coenzyme A reductase(HMGR)and inhibits the development of atherosclerosis by regulating the exosomal miR-223 expression.Methods:Thirty-six male New Zealand rabbits were randomly assigned to a normal group,a model group,and an herb cake-insulated moxibustion group,with 12 rabbits in each group.The model and the herb cake-insulated moxibustion groups were fed a high-fat diet for 8 weeks to induce an atherosclerosis model.Following successful modeling,the herb cake-insulated moxibustion group was subjected to bundling and herb cake-insulated moxibustion intervention,while the other two groups were subjected only to bundling without moxibustion.After 8 weeks of intervention,hematoxylin-eosin(HE)staining was used to observe aortic morphology;the serum levels of total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)were detected using an automatic biochemical analyzer in each group.Exosome morphology was observed using the transmission electron microscope;Western blotting(WB)was used to detect the protein levels of serum exosomal CD63 and CD9 markers,as well as liver HMGR;additionally,real-time fluorescence quantitative polymerase chain reaction was used to quantify serum exosomal miR-223.Results:HE staining showed thickened aortic intima,lipid infiltration,foam cell aggregation,and structural damage to the arterial wall in the model group.Meanwhile,after modeling,the serum levels of LDL-C,TC,and TG increased significantly in the model and herb cake-insulated moxibustion groups compared to the normal group(P<0.05),suggesting successful atherosclerosis rabbit model preparation.The serum exosomes of rabbits in the model group exhibited a saucer-like or semi-concave spherical shape with diameters of 120-150 nm.WB detection results showed positive expression of the exosomal markers CD63 and CD9.After 8 weeks of intervention,the miR-223 level in the model group was significantly lower than that in the normal group(P<0.01).In contrast,the herb cake-insulated moxibustion group demonstrated significantly reduced serum levels of TC,TG,and LDL-C(P<0.05),increased miR-223 expression(P<0.01),and decreased relative liver HMGR protein expression(P<0.05)compared to the model group.Conclusion:Herb cake-insulated moxibustion may alleviate the progression of atherosclerosis by up-regulating exosomal miR-223 expression and down-regulating HMGR protein expression,thereby inhibiting cholesterol anabolic metabolism.

Objective:To investigate the effect of elimination,combination,rearrangement and simplification(ECRS)management combined with risk assessment on reducing the incidence of multidrug-resistant bacteria infections of patients who received mechanical ventilation in intensive care unit(ICU).Methods:The management mode of prevention and control for multidrug-resistant bacteria infections of patients in ICU was optimized on the basis of ECRS management combined with risk assessment.A total of 600 patients who received mechanical ventilation in ICU of Jiuquan Hospital of Shanghai General Hospital(Jiuquan People's Hospital)from January 2022 to December 2023 were selected.According to different management methods,these patients were divided into a control group and an observation group,with 300 cases in each group.The control group was managed by using the risk assessment management method,while the observation group was managed by using the ECRS management on the basis of risk assessment management method.The indicators of respiratory function,patients'satisfaction score,stay time in ICU,time of mechanical ventilation and incidence of multidrug-resistant bacteria were compared between the two groups.Results:The mean value of the ratio of forced expiratory volume in one second(FEV1)to forced vital capacity(FVC)(FEV1/FVC),and the FEV1 level in observation group by using ECRS management combined with risk assessment method were respectively(78.69±4.65)%and(1.58±0.24)L,both of which were higher than those of control group,and the differences of them between two groups were statistically significant(t=16.483,11.742,P<0.05).The average scores of work efficiency,emergency response capability,professional ethics,isolation and resettlement,and overall patients'satisfaction in the observation group were respectively(23.12±1.20),(23.34±1.08),(23.65±1.10),(23.80±1.05)and(92.24±4.37),all of which were higher than those in the control group,and the differences of them between two groups were statistically significant(t=22.176,27.903,22.373,31.364,13.963,P<0.05).The average ICU stay time and the average time of mechanical ventilation were respectively(14.15±1.60)and(9.15±2.13)days in the observation group,both of which were lower than those in the control group,and the differences of them between two groups were statistically significant(t=16.872,15.410,P<0.05).The incidence of multidrug-resistant bacteria was 0.33%in 300 patients of the observation group,which was lower than that of the control group,with a statistically significant difference(x2=4.561,P<0.05).Conclusion:The application of ECRS management combined with risk assessment in the management of ICU for patients who receive mechanical ventilation can protect respiratory function of patients,and decrease the risk of occurring the infection of multidrug-resistant bacteria,and reduce ICU stay time and the time of mechanical ventilation of patients,and improve patients'satisfaction.

Objective To investigate the efficacy of alanyl glutamine combined with octreotide in the treatment of acute pancreatitis(AP)associated lung injury.Methods A total of 94 patients with AP associated lung injury admitted to Jinhua Municipal Central Hospital from June 2022 to June 2024 were selected and divided into observation group and control group according to random number table method,with 47 patients in each group.Patients in control group were treated with octreotide,patients in observation group were treated with alanyl glutamine on the basis of control group.The efficacy,Balthazar CT grading,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,Murray lung injury score(MLIS),Toll-like receptor 4(TLR4),matrix metalloproteinase-9(MMP-9)and blood gas indexes[arterial partial pressure of oxygen(PaO2),arterial oxygen saturation(SaO2)and oxygenation index]were compared between two groups.Results The curative effect of observation group was significantly better than that of control group(x2=5.817,P=0.016).After treatment,the Balthazar CT grading,APACHE Ⅱ score,MLIS score,TLR4 and MMP-9 of patients in two groups were significantly lower than before treatment,while PaO2,SaO2 and oxygenation index were significantly higher than before treatment(P＜0.05).Balthazar CT grading,APACHE Ⅱ score,MLIS score,TLR4 and MMP-9 in observation group were significantly lower than those in control group,while PaO2,SaO2 and oxygenation index were significantly higher than those in control group(P＜0.05).Conclusion Alanyl glutamine combined with octreotide has a significant effect in the treatment of patients with AP associated lung injury,which can improve the clinical symptoms of patients,reduce lung injury and inflammation.

Objective:To explore the effect of preoperative intensive functional training on the balance and functional recovery of patients with knee osteoarthritis (KOA) receiving total knee arthroplasty (TKA).Methods:Sixty KOA patients were randomly divided into an outpatient group, a home-based group and a control group, each of 20. Before their TKAs, both the outpatient and home-based groups underwent intensive functional training for 4 weeks, while the control group did nothing special. After the TKA, all received 4 weeks of standardized postoperative rehabilitation training. Before any training, after the 4 weeks of preoperative training and 4 weeks after the TKAs, all of the subjects performed the timed up and go test (TUGT), and their joint range of motion (ROM) was recorded. They also completed the 30-second chair stand strength test (30sCST), and the 6-minute walk exercise endurance test (6MWT). KOA osteoarthritis indices (WOMACs) were also recorded.Results:After the 4 weeks of preoperative training, significant differences were observed in the trajectory length, elliptical area and TUGT times of both the outpatient and home-based groups. Four weeks after the TKAs, significant differences were observed in all of the measurements in all three groups, but the results of the outpatient and home-based groups were significantly better than those of the control group, on average. After the 4 weeks of postoperative training, there were significant differences between the outpatient and home-based groups in terms of the average knee flexion angle, knee extension angle, 30sCST and 6MWT results. There were significant differences among the 3 groups in all of the measurements 4 weeks after the TKAs, with those of the two training groups showing significantly better results than the control group. The pain scores, stiffness scores, function scores and total WOMAC scores had improved significantly compared with the control group, but the average function and total WOMAC scores of the outpatient group (24.25±2.38) and (35.41±3.02) were then significantly superior to the home-based group′s averages.Conclusions:Intensive preoperative functional training conducted in an outpatient clinic or at home can significantly improve the balance, lower limb strength, exercise endurance and symptoms of KOA patients after TKA.

Objective:To investigate the effect of progressive resistance training on inflammatory markers, motor function and quality of life in the elderly after total knee arthroplasty (TKA).Methods:This study was a randomized controlled trial. A total of 46 elderly patients aged≥60 years who underwent total knee arthroplasty in the Affiliated Hospital 6 of Nantong University from January 2023 to June 2024 were selected and divided into experimental group and control group by computer random number method (23 cases in each group). The control group received routine rehabilitation management intervention, progressive resistance training was added to the experimental group on the basis of the control group, and all patients were intervened for 4 weeks. Interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), 30-Second Chair Stand Test (30sCST), Knee Society Score (KSS), and World Health Organization Quality of Life Scale-Brief Form Questionnaire (WHOQOL-BREF) scores were measured at 1 day before operation, 2 weeks and 4 weeks after operation, and were compared respectively.Results:At 2 and 4 weeks after operation, the levels of IL-6 [(22.44±2.17) and (9.91±1.41) pg/ml], CRP[(19.61±2.20) and (3.17±0.40) mg/L] and ESR[(44.85±3.78) and (28.28±3.31) mm/1 h] in the experimental group were significantly lower than those in control group [IL-6: (24.65±1.77) and (11.35±1.67) pg/ml, CRP: (23.24±2.69) and (4.15±0.45) mg/L and ESR: (48.54±3.66) and (34.60±2.98) mm/1 h](all P<0.05). At 2 and 4 weeks after operation, the 30sCST[(9.87±0.92) and (11.83±1.03) times], clinical scores of KSS[(48.44±3.13) and (71.09±3.30) points], functional scores of KSS[(40.44±3.96) and (69.35±4.07) points] in the experimental group were significantly higher than those in control group [30sCST: (9.30±0.70) and (10.52±0.79) times, clinical scores of KSS: (46.17±2.86) and (67.00±2.89) points, functional scores of KSS: (38.91±3.68) and (66.30±5.05) points](all P<0.05). At 2 weeks after operation, the scores of physical health, mental health and social relations in the WHOQOL-BREF of the experimental group [(16.96±1.02), (17.96±1.46) and (6.74±0.62) points], which were significantly higher than those in the control group [(16.09±1.08), (17.14±1.12), (6.44±0.51) points](all P<0.05). There was no significant difference in the environmental condition score between the two groups. At 4 weeks after operation, the scores of physical health, mental health, social relations and environmental conditions in WHOQOL-BREF of the experimental group [(22.09±1.81), (22.17±2.19), (12.09±1.28) and (33.91±2.26) points] were significantly higher than those in the control group [(19.65±1.80), (20.39±1.95), (10.17±1.30), (31.96±2.51) points] (all P<0.05). Conclusion:Progressive resistance training can effectively reduce the inflammatory response in the elderly after total knee arthroplasty, enhance lower limb muscle strength and knee joint function, and improve the quality of life.

Objective To systematically review the safety of budesonide inhalation aerosol in the treatment of chronic obstructive pulmonary disease.Methods PubMed,Cochrane Library,Web of Science,Embase,CNKI,WanFang Data,VIP and SinoMed databases were electronically searched to collect randomized controlled trials on budesonide inhalation aerosol in the treatment of chronic obstructive pulmonary disease from inception to June 30,2024.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.The Meta-analysis was performed by using RevMan 5.3 software.Results A total of 52 studies with 16,768 patients were included.Meta-analysis results showed that the incidence of respiratory system adverse drug reaction(ADR)was higher in the budesonide group than in the control group,with a statistically significant difference[OR=1.18,95％CI(1.10,1.27),P＜0.001].There was no statistically significant difference in the incidence of overall ADR,central and peripheral nervous system ADR,gastrointestinal system ADR,skin ADR,urinary system ADR,infectious disease ADR,and musculoskeletal system ADR between the two groups of patients(P＞0.05).According to the subgroup analysis of the treatment course,in the 3-6 month subgroup,the incidence of ADR was higher in the budesonide group than in the control group,with a statistically significant difference[OR=1.43,95％CI(1.18,1.74),P＜0.001].In the studies with a treatment duration of more than 6 months,the incidence of ADR was higher in the budesonide group than in the control group,with a statistically significant difference[OR=1.54,95％CI(1.16,2.03),P=0.002].In the study of unknown treatment course,the incidence of ADR in the budesonide group was lower than that in the control group,and the difference was statistically significant[OR=0.39,95％CI(0.20,0.76),P=0.005].In the studies with a treatment duration of less than 3 months,the incidence of ADR in the budesonidegroup was comparable to that in the control group(P＞0.05).Conclusion The incidence of respiratory ADR caused by budesonide is higher than that of the control group.Although the incidence of overall ADR is not statistically significant,the occurrence of systemic adverse reactions should continue to be closely monitored in the future treatment of chronic obstructive pulmonary disease.

Objective To systematically review the safety of budesonide inhalation aerosol in the treatment of chronic obstructive pulmonary disease.Methods PubMed,Cochrane Library,Web of Science,Embase,CNKI,WanFang Data,VIP and SinoMed databases were electronically searched to collect randomized controlled trials on budesonide inhalation aerosol in the treatment of chronic obstructive pulmonary disease from inception to June 30,2024.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.The Meta-analysis was performed by using RevMan 5.3 software.Results A total of 52 studies with 16,768 patients were included.Meta-analysis results showed that the incidence of respiratory system adverse drug reaction(ADR)was higher in the budesonide group than in the control group,with a statistically significant difference[OR=1.18,95％CI(1.10,1.27),P＜0.001].There was no statistically significant difference in the incidence of overall ADR,central and peripheral nervous system ADR,gastrointestinal system ADR,skin ADR,urinary system ADR,infectious disease ADR,and musculoskeletal system ADR between the two groups of patients(P＞0.05).According to the subgroup analysis of the treatment course,in the 3-6 month subgroup,the incidence of ADR was higher in the budesonide group than in the control group,with a statistically significant difference[OR=1.43,95％CI(1.18,1.74),P＜0.001].In the studies with a treatment duration of more than 6 months,the incidence of ADR was higher in the budesonide group than in the control group,with a statistically significant difference[OR=1.54,95％CI(1.16,2.03),P=0.002].In the study of unknown treatment course,the incidence of ADR in the budesonide group was lower than that in the control group,and the difference was statistically significant[OR=0.39,95％CI(0.20,0.76),P=0.005].In the studies with a treatment duration of less than 3 months,the incidence of ADR in the budesonidegroup was comparable to that in the control group(P＞0.05).Conclusion The incidence of respiratory ADR caused by budesonide is higher than that of the control group.Although the incidence of overall ADR is not statistically significant,the occurrence of systemic adverse reactions should continue to be closely monitored in the future treatment of chronic obstructive pulmonary disease.

Objective:To investigate whether herb cake-insulated moxibustion affects the expression of cholesterol metabolism-related protein 3-hydroxy-3-methylglutaryl coenzyme A reductase(HMGR)and inhibits the development of atherosclerosis by regulating the exosomal miR-223 expression.Methods:Thirty-six male New Zealand rabbits were randomly assigned to a normal group,a model group,and an herb cake-insulated moxibustion group,with 12 rabbits in each group.The model and the herb cake-insulated moxibustion groups were fed a high-fat diet for 8 weeks to induce an atherosclerosis model.Following successful modeling,the herb cake-insulated moxibustion group was subjected to bundling and herb cake-insulated moxibustion intervention,while the other two groups were subjected only to bundling without moxibustion.After 8 weeks of intervention,hematoxylin-eosin(HE)staining was used to observe aortic morphology;the serum levels of total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)were detected using an automatic biochemical analyzer in each group.Exosome morphology was observed using the transmission electron microscope;Western blotting(WB)was used to detect the protein levels of serum exosomal CD63 and CD9 markers,as well as liver HMGR;additionally,real-time fluorescence quantitative polymerase chain reaction was used to quantify serum exosomal miR-223.Results:HE staining showed thickened aortic intima,lipid infiltration,foam cell aggregation,and structural damage to the arterial wall in the model group.Meanwhile,after modeling,the serum levels of LDL-C,TC,and TG increased significantly in the model and herb cake-insulated moxibustion groups compared to the normal group(P<0.05),suggesting successful atherosclerosis rabbit model preparation.The serum exosomes of rabbits in the model group exhibited a saucer-like or semi-concave spherical shape with diameters of 120-150 nm.WB detection results showed positive expression of the exosomal markers CD63 and CD9.After 8 weeks of intervention,the miR-223 level in the model group was significantly lower than that in the normal group(P<0.01).In contrast,the herb cake-insulated moxibustion group demonstrated significantly reduced serum levels of TC,TG,and LDL-C(P<0.05),increased miR-223 expression(P<0.01),and decreased relative liver HMGR protein expression(P<0.05)compared to the model group.Conclusion:Herb cake-insulated moxibustion may alleviate the progression of atherosclerosis by up-regulating exosomal miR-223 expression and down-regulating HMGR protein expression,thereby inhibiting cholesterol anabolic metabolism.

Objective:To investigate the effect of elimination,combination,rearrangement and simplification(ECRS)management combined with risk assessment on reducing the incidence of multidrug-resistant bacteria infections of patients who received mechanical ventilation in intensive care unit(ICU).Methods:The management mode of prevention and control for multidrug-resistant bacteria infections of patients in ICU was optimized on the basis of ECRS management combined with risk assessment.A total of 600 patients who received mechanical ventilation in ICU of Jiuquan Hospital of Shanghai General Hospital(Jiuquan People's Hospital)from January 2022 to December 2023 were selected.According to different management methods,these patients were divided into a control group and an observation group,with 300 cases in each group.The control group was managed by using the risk assessment management method,while the observation group was managed by using the ECRS management on the basis of risk assessment management method.The indicators of respiratory function,patients'satisfaction score,stay time in ICU,time of mechanical ventilation and incidence of multidrug-resistant bacteria were compared between the two groups.Results:The mean value of the ratio of forced expiratory volume in one second(FEV1)to forced vital capacity(FVC)(FEV1/FVC),and the FEV1 level in observation group by using ECRS management combined with risk assessment method were respectively(78.69±4.65)%and(1.58±0.24)L,both of which were higher than those of control group,and the differences of them between two groups were statistically significant(t=16.483,11.742,P<0.05).The average scores of work efficiency,emergency response capability,professional ethics,isolation and resettlement,and overall patients'satisfaction in the observation group were respectively(23.12±1.20),(23.34±1.08),(23.65±1.10),(23.80±1.05)and(92.24±4.37),all of which were higher than those in the control group,and the differences of them between two groups were statistically significant(t=22.176,27.903,22.373,31.364,13.963,P<0.05).The average ICU stay time and the average time of mechanical ventilation were respectively(14.15±1.60)and(9.15±2.13)days in the observation group,both of which were lower than those in the control group,and the differences of them between two groups were statistically significant(t=16.872,15.410,P<0.05).The incidence of multidrug-resistant bacteria was 0.33%in 300 patients of the observation group,which was lower than that of the control group,with a statistically significant difference(x2=4.561,P<0.05).Conclusion:The application of ECRS management combined with risk assessment in the management of ICU for patients who receive mechanical ventilation can protect respiratory function of patients,and decrease the risk of occurring the infection of multidrug-resistant bacteria,and reduce ICU stay time and the time of mechanical ventilation of patients,and improve patients'satisfaction.

Objective To investigate the efficacy of alanyl glutamine combined with octreotide in the treatment of acute pancreatitis(AP)associated lung injury.Methods A total of 94 patients with AP associated lung injury admitted to Jinhua Municipal Central Hospital from June 2022 to June 2024 were selected and divided into observation group and control group according to random number table method,with 47 patients in each group.Patients in control group were treated with octreotide,patients in observation group were treated with alanyl glutamine on the basis of control group.The efficacy,Balthazar CT grading,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,Murray lung injury score(MLIS),Toll-like receptor 4(TLR4),matrix metalloproteinase-9(MMP-9)and blood gas indexes[arterial partial pressure of oxygen(PaO2),arterial oxygen saturation(SaO2)and oxygenation index]were compared between two groups.Results The curative effect of observation group was significantly better than that of control group(x2=5.817,P=0.016).After treatment,the Balthazar CT grading,APACHE Ⅱ score,MLIS score,TLR4 and MMP-9 of patients in two groups were significantly lower than before treatment,while PaO2,SaO2 and oxygenation index were significantly higher than before treatment(P＜0.05).Balthazar CT grading,APACHE Ⅱ score,MLIS score,TLR4 and MMP-9 in observation group were significantly lower than those in control group,while PaO2,SaO2 and oxygenation index were significantly higher than those in control group(P＜0.05).Conclusion Alanyl glutamine combined with octreotide has a significant effect in the treatment of patients with AP associated lung injury,which can improve the clinical symptoms of patients,reduce lung injury and inflammation.