With the rapid advancement of hemodynamic indices and monitoring technologies, their classification methods and application processes have become increasingly complex. Currently, no unified standard hasbeen established, making it difficult to fully meet the clinical requirements for hemodynamic management. To assist in hemodynamic monitoring assessment and therapeutic decision-making in critically ill patients, the Critical Hemodynamic Therapy Collaborative Group, in conjunction with the Critical Ultrasound Study Group, has jointly developed the Standard for the Application of Hemodynamic Monitoring Techniques in Critical Care. The first part of this standard systematically categorizes hemodynamic indicators into flow indicators, pressure and its derivative indicators, and tissue perfusion indicators, while elaborating on the clinical application of each. The second part establishes a standardized clinical implementation pathway for hemodynamic monitoring. It proposes a tiered monitoring strategy-comprising basic, advanced, indication-specific, and special scenario monitoring-tailored to different clinical settings. It emphasizes the central role of critical care ultrasound across all levels of monitoring and establishes hemodynamic assessment standards for organs such as the brain, kidneys, and gastrointestinal tract. This standard aims to provide a unified framework for clinical practice, teaching, training, and research in critical care medicine, thereby promoting standardized development within the discipline.

Objective To evaluate the efficacy and safety of six kinds of commonly used traditional Chi-nese medicine combined with mesalazine in the treatment of ulcerative colitis(UC)based on frequency statis-tical network meta-analysis.Methods Randomized controlled trials(RCT)of oral Chinese medicine for the treatment of UC were searched from the establishment of the database to June 2024 of PubMed,CNKI,Wan-fang,VIP,Sinomed and other databases.The quality of the included literatures was evaluated by Cochrane bias risk assessment tool,and the data were statistically analyzed by Stata MP17.0 software.Results A total of 24 RCTs involving 1 939 patients were included,involving 6 kinds of traditional Chinese medicine and Chinese pa-tent medicine,including 4 macro and micro outcome indicators.In terms of improving the total clinical effec-tive rate,Shaoyao decoction,Gancao Xiexin decoction,Huangqin decoction granule,Baitouweng decoction,Kangfuxin liquid,Shenlingbaizhu powder+mesalazine were all superior to using mesalazine alone,and Kang-fuxin liquid+mesalazine had the best effect(P<0.05).In terms of down-regulation of interleukin(IL)-6 expression in colonic mucosa,Shaoyao decoction,Gancao Xiexin Decoction,Huangqin Decoction granules,Pul-satilla decoction,Kangfuxin Liquid+mesalazine were better than using mesalazine alone,and Pulsatilla De-coction+mesalazine had the best effect on reducing IL-6(P<0.05).In terms of down-regulation of colonic mucosal tumor necrosis factor(TNF)-α expression,Shaoyao decoction,Gancao Xiexin decoction,Huangqin decoction granule,Baitouweng decoction,Shenlingbaizhu decoction+mesalazine was better than using me-salazine alone,and Gancao Xiexin decoction+mesalazine had the best effect(P<0.05).In terms of down-regulation of IL-10 expression in colonic mucosa,Pulsatilla decoction+mesalazine was better than mesalazine alone(P<0.05).Conclusion Traditional Chinese medicine combined with mesalazine could alleviate the clin-ical symptoms of UC patients,improve inflammatory factor indicators,eliminate inflammation,and show a better treatment effect for UC than mesalazine used alone.

Objective:To investigate the concern about pollen broadcasting in Chinese population from multiple dimensions and to understand the information about allergic rhinitis (AR) in China by analyzing related factors.Methods:From March 1 to September 30, 2022, a large-scale multi-center cross-sectional survey was conducted based on the Questionnaire Star platform in 21 Chinese hospitals. A total of 7 056 subjects from 7 regions in China: Northeast, North, East, Central, South, Southwest, and Northwest China were included. Basic characteristics (including social demographic characteristics and disease characteristics of AR patients), concern about pollen broadcasting, the willingness of pollen-induced AR (PiAR) patients to receive pollen broadcasting, and the treatment satisfaction rate of AR patients were collected. The chi-square test, multivariate linear regression model, and Logistic regression analysis were used to analyze the concern about pollen broadcasting in the Chinese population and related factors from multiple dimensions.Results:Among 7 056 subjects, 23.02% were concerned about pollen broadcasting. Among 3 176 self-reported AR and 1 019 PiAR patients, 25.60% and 39.16% were concerned about pollen broadcasting, respectively, which was higher than that of non-AR or non-PiAR subjects ( χ2 value was 21.74 and 175.11, respectively, both P<0.001). Among AR patients, the proportion of spring and autumn allergen-positive patients concerned about pollen broadcasting was higher than that in perennial allergen-positive patients ( χ2 value was 20.90 and 19.51, respectively, both P<0.001). The proportion of AR patients with asthma, sinusitis, allergic conjunctivitis, and cardiovascular and cerebrovascular diseases was higher than those without complications ( χ2 value was 50.83, 21.97, 56.78, 7.62, respectively, all P<0.05). The proportion of AR patients in North China who could find pollen broadcasting locally was 31.01%, significantly higher than those in other regions (all P<0.05). Multivariate linear regression model analysis showed that among PiAR patients, those with higher per capita household income and higher AR disease cognition levels had been concerned about pollen broadcasting in the past, and those complicated with allergic conjunctivitis had stronger intention to receive pollen broadcasting (B value was 0.24, 0.13, 0.66, 0.47, respectively, all P<0.05). The higher the disease cognition level of PiAR patients, the stronger their willingness to actively participate in treatment ( R2=0.72, P<0.001). Only 18.89% of AR patients felt satisfied with the treatment effect. Logistic regression analysis showed that in AR patients, the treatment satisfaction rate was significantly higher among those concerned about pollen broadcasting compared to those who were not ( OR=1.83, P<0.001). Conclusions:Currently, the dissemination of pollen broadcasting in China is hindered by various factors such as disease cognition level. The treatment satisfaction among AR patients remains unsatisfactory.

AIM: To understand the publication status, research trends, and cutting-edge and hot topics in this field by conducting a bibliometrics analysis of relevant literatures on the pathogenesis of primary open angle glaucoma(POAG)in the past 30 a.METHODS:A total of 986 relevant literatures on the pathogenesis of POAG published on the core databases of China National Knowledge Infrastructure(CNKI)and Web of Science(WOS)from 1 September 1993 to 1 September 2023 were retrieved. CiteSpace(6.2.R.4)and VOSviewer(1.6.18)software were used to conduct knowledge graph analysis on the retrieved literature, including publication volume, author, research institution, country/region, and keywords.RESULTS:The United States(243 articles)has the highest number of publications, followed by China(121 articles). The foreign institution with the highest number of publications is Harvard University(37 articles), while domestic institutions such as Zhongshan Ophthalmic Center, Sun Yat-sen University, ophthalmology department of Xuanwu Hospital of Capital Medical University, and Peking University First Hospital tied for the highest number of publications. Louis R. Pasquale(21 articles)is the most prolific English author. Wang Ningli is the most active Chinese researcher in this field. Keywords include trabecular meshwork, intraocular pressure, aqueous humor, glucocorticoid, hemorheology, etc.CONCLUSION: The research on the pathogenesis of POAG is in a period of vigorous development. The United States has the largest number of publications in this field, and Harvard University is a leading institution in this field. The research focus in the field of POAG has shifted from the structural aspect to the genetic level, and gene research and traditional Chinese medicine treatment have broad application prospects in this field.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

Objective:To observe the clinical efficacy of combining contralateral needling and tendon-bone balancing Tuina(Chinese therapeutic massage)in treating scapulohumeral periarthritis(SP). Methods:Sixty-eight eligible participants were chosen and randomized into an acupuncture group and an acupuncture plus Tuina group,with 34 cases in each group.The acupuncture group received treatment with contralateral needling,and the acupuncture plus Tuina group was treated with contralateral needling combined with tendon-bone balancing Tuina.The post-treatment changes in the Constant-Murley score for comprehensive shoulder function,visual analog scale(VAS)score for pain,and shoulder range of motion(ROM)score were compared after 2 treatment courses to estimate the clinical efficacy in the two groups. Results:After treatment,the total effective rate was 96.7%in the acupuncture plus Tuina group versus 83.9%in the acupuncture group,showing a significant difference between the two groups(P<0.05).The Constant-Murley shoulder function score increased in the acupuncture plus Tuina group after the intervention;a decreased VAS pain score and an increased shoulder ROM score were found in both groups.After 1 and 2 treatment courses,the between-group comparisons of the Constant-Murley and shoulder ROM scores showed statistical significance(P<0.05).Regarding the VAS score,the acupuncture plus Tuina group was lower than the acupuncture group after the first treatment course(P<0.05),but there was no significant difference between the two groups after 2 treatment courses(P>0.05). Conclusion:Contralateral needling plus tendon-bone balancing Tuina can produce more significant clinical efficacy and relieve pain faster than contralateral needling alone in treating SP.

Objective:To explore the risk factors and prognosis of sepsis-related cardiomyopathy.Methods:Patients with sepsis and septic shock admitted to the Critical Care Medicine Department at Peking Union Medical College Hospital from October 2017 to February 2021 were enrolled. Echocardiographic parameters including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and cardiac index (CI) were obtained within 24 h after admission. Hemodynamic parameters including heart rate, mean arterial pressure and central venous pressure were also collected. The risk factors of 45-day mortality were analyzed using Cox regression analysis. Kaplan-Meier survival analysis was performed to compare 45-day mortality among patients with normal left ventricle (LV) systolic function group, sepsis-related takotsubo cardiomyopathy (ST) and septic cardiomyopathy (SC) group as well as between patients with normal right ventricular (RV) function and patients with RV dysfunction.Results:According to LV systolic function, patients were categorized into three groups: normal group [174 (66.9%)], SC group [66 (25.4%)] and ST group [66 (25.4%)]. In comparison with those in normal group, patients in SC group and ST group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score ( P<0.05). No difference was found between SC group and ST group regarding APACHE Ⅱ score and SOFA score( P>0.05). ST group had lower LVEF [33(28, 41)% vs. 45(38, 48)%, P<0.05], CI [2.29 (1.99, 2.53)L·min -1·m -2 vs. 3.04(2.61, 3.61) L·min -1·m -2, P<0.05] higher TAPSE [18.6(16.0, 21.2)mm vs. 15.1(12.5, 19.0)mm, P<0.05] than SC group. A Cox regression survival analysis showed that right ventricular dysfunction (RVD) was an independent predictor of 45-day mortality ( HR=1.992, 95% CI 1.088-3.647, P=0.025). A Kaplan-Meier analysis revealed no significant difference regarding 45-day mortality among ST group [25.0%(5/20)], SC group [30.3%(20/66)] and normal group 18.4%(32/174)( P=0.158). RVD patients [38.0%(30/79)] had significantly higher 45-day mortality than patients with normal RV function [14.9%(27/181), P<0.001]. Conclusions:In comparison with SC patients, ST patients tend to have worse LV systolic function, lower cardiac output and better RV function. However, neither ST nor SC is associated with 45-day mortality. RVD is a risk predictor of 45-day mortality, which should be monitored in septic patients.

Objective:To explore the relationship between the pulse pressure/central venous pressure (PP/CVP) ratio and the cardiac output (CO) of patients after cardiac surgery from the basic principles of hemodynamics, and to further evaluate the predictive value of PP/CVP ratio in patients with secondary low cardiac output syndrome (LCOS) after cardiac surgery.Methods:A retrospective study was conducted, and patients who received pulse indicator continuous cardiac output (PiCCO) monitoring were enrolled at the department of critical care medicine of Peking Union Medical College Hospital from January 1, 2016, to September 1, 2021. Patients were divided into two groups: the LCOS group [cardiac index (CI) < 33.34 mL·s -1·m -2, 25 cases] and the non-LCOS group (CI ≥ 33.34 mL·s -1·m -2, 125 cases) according to the CI at 6 hours after surgery. The general clinical data and hemodynamic parameters were collected. Correlations between PP/CVP ratio and PiCCO monitoring indicators were performed with Pearson or Spearman correlation test. Receiver operator characteristic curve (ROC curve) analysis was carried out to evaluate the predictive value of the parameters in patients with LCOS after cardiac surgery. Results:A total of 150 patients with PiCCO monitoring after cardiac surgery were included. There were no differences in baseline characteristics between the two groups, while PP in the LCOS group was lower than that in the non-LCOS group [mmHg (1 mmHg ≈ 0.133 kPa): 40 (37, 44) vs. 55 (46, 64)], CVP was higher than that in the non-LCOS group [mmHg: 12 (11, 14) vs. 10 (8, 12)], and PP/CVP ratio in the LCOS group was lower than that in the non-LCOS group [3.3 (2.9, 3.7) vs. 5.5 (4.6, 6.8)], with significant differences (all P < 0.05). Correlation analysis results showed that PP/CVP ratio was positively correlated with CI, CO, and stroke volume index (SVI), respectively ( rs = 0.660, 0.592, 0.600, all P < 0.001). CI was negatively correlated with PP ( rs = 0.509, P < 0.001) and positively correlated with CVP ( rs = -0.297, P < 0.001). ROC curve analysis revealed that compared with PP, CVP, SVI and cardiac function index (CFI), PP/CVP ratio was the best predictor of LCOS after cardiac surgery [area under the ROC curve (AUC) was 0.94±0.02, P < 0.001], when the optimum cut-off value was 4.41, the sensitivity was 80.00%, and the specificity was 96.00%. Conclusion:PP/CVP ratio was moderately positively correlated with CO after cardiac surgery, and PP/CVP ratio could be used as a prognostic predictor for LCOS after cardiac surgery.

Antibody-mediated rejection (AMR) is one of the major causes of graft loss after transplantation. Recently, the regulation of B cell differentiation and the prevention of donor-specific antibody (DSA) production have gained increased attention in transplant research. Herein, we established a secondary allogeneic in vivo skin transplant model to study the effects of romidepsin (FK228) on DSA. The survival of grafted skins was monitored daily. The serum levels of DSA and the number of relevant immunocytes in the recipient spleens were evaluated by flow cytometry. Then, we isolated and purified B cells from B6 mouse spleens in vitro by magnetic bead sorting. The B cells were cultured with interleukin-4 (IL-4) and anti-clusters of differentiation 40 (CD40) antibody with or without FK228 treatment. The immunoglobulin G1 (IgG1) and IgM levels in the supernatant were evaluated by enzyme-linked immunosorbent assay (ELISA). Quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and western blotting were conducted to determine the corresponding levels of messenger RNA (mRNA) and protein expression in cultured cells and the recipient spleens. The results showed that FK228 significantly improved the survival of allogeneic skin grafts. Moreover, FK228 inhibited DSA production in the serum along with the suppression of histone deacetylase 1 (HADC1) and HDAC2 and the upregulation of the acetylation of histones H2A and H3. It also inhibited the differentiation of B cells to plasma cells, decreased the transcription of positive regulatory domain-containing 1 (Prdm1) and X-box-binding protein 1 (Xbp1), and decreased the expression of phosphorylated inositol-requiring enzyme 1 α (p-IRE1α), XBP1, and B lymphocyte-induced maturation protein-1 (Blimp-1). In conclusion, FK228 could decrease the production of antibodies by B cells via inhibition of the IRE1α-XBP1 signaling pathway. Thus, FK228 is considered as a promising therapeutic agent for the clinical treatment of AMR.
Animals ; Depsipeptides ; Endoribonucleases ; Hematopoietic Stem Cell Transplantation ; Histone Deacetylase Inhibitors/pharmacology* ; Mice ; Protein Serine-Threonine Kinases ; Skin Transplantation

Objective:To explore a new method of diagnosing and identifying renal transplantation clinical almost tolerance through a diagnostic model using plasma proteomics.Methods:From November 2011 to November 2012, plasma samples from 43 subjects were collected and divided into the groups of clinical almost tolerance(18 cases), rejection(12 cases)and healthy control(13 cases). Protemic analysis of plasma samples was performed by surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS). Differential mass spectrometry peaks were screened and diagnostic model was established by Biomarker Wizard and Biomarker Pattern software. Identification of mass spectrometric peaks of nodes in the diagnostic model was carried out by searching the databases of SWISS-PROT and TrEMBL using ExPASy's TagIdent tool.Results:A total of 21 differential proteins peaks were obtained( P<0.05). Diagnostic model was composed of five mass spectrum peaks of 2 565.15, 1 966.28, 6 674.78, 1 103.27, 1 716.69 and 1 966.28.The sensitivity, specificity and area under the ROC curve of model were 83.3%, 92.0% and 0.951 respectively for diagnosing clinical almost tolerance.Bioinformatic identification results of mass spectrometric peaks of nodes in model were proteins of ANFB, MCH, TFF1, PDYN and PSME3. Conclusions:Establishing a diagnostic mode by plasma proteomics may be effectively employed for diagnosing clinical almost tolerance in kidney transplant.