ObjectiveTo explore the effect of semaglutide （SEM） on myocardial injury induced by coronary microembolization （CME） in rats via the adenosine monophosphate-activated protein kinase （AMPK）/nucleotide-binding oligomerization domain-like receptor protein 3 （NLRP3） signaling pathway. MethodsThirty-two rats were randomly assigned to four groups （n=8）： the Sham group， the CME group， the CME + SEM group， and the CME + SEM + Compound C （CC， a specific inhibitor of AMPK） group. The CME model was established by injecting microembolic spheres into the left ventricle， while the Sham group received an equal volume of normal saline via left ventricular injection. The CME + SEM group received subcutaneous injections of SEM （1 mg/kg， once weekly） for 4 weeks before CME induction. For the CME + SEM + CC group， rats were treated with SEM for 4 weeks， followed by an intravenous injection of CC （0.25 mg/kg dissolved in sterile normal saline） 30 minutes before CME modeling. 24 hours post-modeling， all groups underwent the following assessments： echocardiography to evaluate cardiac function， HE staining for myocardial histopathological analysis， Heidenhain staining to quantify the microinfarct area， ELISA to determine serum cardiac troponin T （cTnT） levels， and Western blot analysis to detect the expression of proteins related to the AMPK/NLRP3 pathway in cardiac tissues. ResultsCompared with the Sham group， the CME group showed significantly deteriorated cardiac function， elevated serum cTnT levels， and a marked increase in myocardial microinfarct area （P<0.05）. Compared with the CME group， the CME + SEM group exhibited significant improvements in cardiac function， decreased cTnT levels， and a remarkable reduction in myocardial microinfarct area （P<0.05）. Histopathological analysis revealed a normal myocardial structure in the Sham group without infarction. In contrast， the CME group showed disorganized myocardial arrangement， accompanied by nuclear fragmentation and karyolysis. In the CME + SEM group， myocardial degeneration， edema and inflammatory cell infiltration were obviously alleviated. Compared with Sham group， the protein ratio of p-AMPK/AMPK slightly increased in the CME group， while the protein levels of NLRP3， gasdermin D-N domain （GSDMD-N）， apoptosis-associated speck-like protein containing a CARD （ASC）， caspase-1 p20， interleukin（IL）-1β ， and IL-18 were markedly upregulated （P<0.05）. Notably， compared to the CME group， the CME + SEM group had a further elevated p-AMPK/AMPK ratio， while the protein levels of NLRP3， GSDMD-N， ASC， caspase-1 p20， IL-1β and IL-18 were markedly decreased （P<0.05）. ConclusionSEM significantly ameliorates CME-induced myocardial injury， and its mechanism of action may be closely associated with promoting AMPK phosphorylation， inhibiting NLRP3 inflammasome-mediated inflammatory responses， and suppressing pyroptosis.

Objective To explore the clinical effect of cold treatment of replacement fluid in continuous blood purification(CBP)of patients with heat stroke.Methods Clinical data of 46 patients with heat stroke who were treated with CBP in Hainan Hospital of PLA General Hospital from July 2018 to September 2022 were retrospectively analyzed.The patients were assigned to control group(23 cases,conventional treatment for heat stroke and CBP with room temperature replacement fluid)and observation group(23 cases,conventional treatment for heat stroke and CBP with cooling replacement fluid).The body temperatures were compared between the two groups before treatment and 30 min,2 h,6 h,12 h and 24 h after treatment.The prothrombin activity(PTA),activated partial thromboplastin time(APTT),D-dimer(D-D),fibrinogen(FIB)and platelet count(PLT)before treatment and at 24 h(T1),3 d(T2)and 7 d(T3)after treatment,as well as the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score at 7 d after treatment were also compared between the two groups.Results There was no significant difference in temperature or coagulation function between the two groups before treatment(P>0.05).The temperature of the observation group was significantly different from that of the control group at 2 h,6h and 12h after treatment(P<0.05).After treatment,the levels of PTA,FIB and PLT in the observation group at T1,T2 and T3 were higher than those in the control group,while the level of D-D in the observation group was lower than that in the control group,and the APPT at T1 and T2 was significantly shorter than that in the control group(P<0.05).PTA,APPT,D-D,FIB and PLT of the two groups were improved after treatment(P<0.05).Conclusion The cold treatment of replacement fluid can quickly shorten the cooling time of patients with heat stroke during CBP,and significantly improve coagulation function.It is worthy of clinical promotion so as to improve the progrosis of patients with heat strok.

Objective:To evaluate the diagnostic value of intestinal regional oxygen saturation（rSO 2）and fecal calprotectin in the occurrence and severity of necrotizing enterocolitis（NEC）in premature infants. Methods:A prospective observational study was conducted among premature infants admitted to Quanzhou Children's Hospital from October 2019 to December 2022. Intestinal rSO 2 was monitored within two hours of diagnosis of NEC，and fecal calprotectin was measured. Results:A total of 60 patients were included, including 30 cases with NEC and 30 cases without NEC, 14 cases of medical NEC, 16 cases of surgical NEC, and eight infants died due to NEC. Infants with NEC had lower intestinal rSO 2 [49（30，60）% vs. 66（60，69）%] and higher calprotectin levels [479（297，886）μg/g vs. 203（113，275）μg/g] than those in infants without NEC ( P<0.01). The levels of intestinal rSO 2 were lower in surgical NEC than those in medical NEC，and were lower in the death group than that in the survival group ( P<0.01)，but no similar difference was found in the levels of calprotectin. ROC curve analysis showed that intestinal rSO 2 combined with calprotectin had a sensitivity of 73%，a specificity of 100%，and the largest area under curve of 0.91 in the diagnosis of NEC. Intestinal rSO 2 had an optimal cut-off value of 31% in predicting death in infants with NEC，with a sensitivity of 100%，a specificity of 95%，and an area under curve of 0.99. Conclusion:Intestinal rSO 2 and fecal calprotectin can effectively identify the presence of NEC，and their combined detection can improve the diagnostic efficiency. Intestinal rSO 2 is a good predictor of the severity of NEC，but not fecal calprotectin.

Objective Starting from the actual numbers of health personnel of tertiary public hospitals of Traditional Chinese Medicine(TCM),to quantitatively analyze the influencing factors on the allocation of human resources and obtain a prediction model.Methods The balanced panel data from 517 Tertiary Public TCM Hospitals in the period of 2011-2020 were collected,and the two-way fixed effects model was used to empirically analyze the impact of scale,demand and other factors on the actual number of health personnel in these hospitals.Result The number of beds is a key factor affecting the human resource allocation of Public TCM Hospitals,and various factors such as de-mand,policy,price,efficiency,and administrative management also have significant impacts on the allocation.The demand for outpatient services,government financial support,and efficiency of resource utilization are all promoting factors,while the increase in human resource prices,income generation efficiency,and administrative manage-ment levels have negative effects.A prediction model is proposed.Conclusion The planning principle of matching bed numbers with human resources allocation is in line with the actual environment.When predicting the total personnel allocation or authorized strength,various factors should also be fully considered,which can provide reference for the formulation of human resource policies in Public TCM Hospitals.

Undergraduates in colleges and universities have great academic potential. In order to cultivate undergraduate innovative scientific research talents, the key is to improve the cultivation mode of undergraduates and stimulate students' academic potential. Taking the evidence-based medicine research group of Guangdong Medical University as an example, this paper systematically analyzes the specific measures and relevant practical experiences of the research team in the cultivation of undergraduates. The research team creatively uses the methods of "student guidance system", "PBL" mode and real-time feedback mechanism, and a complete talent training system has formed to explore a group of excellent undergraduate talents. Through innovative scientific research training, these undergraduates have made many achievements in academic research. This paper hopes these strategies and experiences can provide some reference for the cultivation of undergraduates in colleges and universities all over the country.

Objective:To investigate the efficacy and safety of targeted therapy with Crizotinib for children with ALK gene mutation positive inflammatory myofibroblastic tumor (IMT). Methods:A retrospective analysis was performed on 4 children with ALK gene mutation positive IMT admitted to Shanghai Children′s Hospital from January 2019 to June 2021.Among them, 3 cases were given the targeted drug Crizotinib[280 mg/(m 2· time), q12h] orally, and 1 case was observed after complete tumor resection to analyze the efficacy and adverse drug reactions. Results:All 4 cases were male, aged from 2 years and 3 months to 11 years and 3 months.The tumors originated from the abdominal cavity in 2 cases, the right orbit in 1 case, and the right lung in 1 case.Pathological immunohistochemistry and fluorescence in situ hybridization were both positive for ALK gene mutation, and complete remission was achieved after comprehensive treatment.Among them, 3 patients were treated with oral Crizotinib, and 2 patients were tried to stop taking the drug for 1 year, relapsed 1 month later, and still achieved complete remission after the second treatment.The 4 cases were followed up for 8-30 months, and all survived.All the cases showed no abnormalities in blood image, liver and kidney function, myocardial enzyme profile, cardiac function, hearing and vision, and 2 cases showed prolonged Q-T interval in the course of Crizotinib treatment, which could be recovered by temporary withdrawal of drug, and no abnormality in electrocardiogram was found in continued drug use. Conclusions:Crizotinib was used to treat ALK mutation positive IMT, shrink tumor and consolidate postoperative treatment, which is a good choice for IMT in children with difficult surgical resection and refractory recurrence.

OBJECTIVE: To explore the bidirectional regulation of acupuncture based on a subgroup analysis of multicenter randomized controlled trial of acupuncture with METHODS: A total of 519 patients were included in the analysis, including 137 patients with constipation type irritable bowel syndrome (IBS-C) (92 cases in the acupuncture group and 45 cases in the polyethylene glycol [PEG] group), and 382 patients with diarrhea type irritable bowel syndrome (IBS-D) (252 cases in the acupuncture group and 130 cases in the pinaverium group). The patients in the acupuncture group were given acupuncture at Baihui (GV 20), Yintang (GV 29), Tianshu (ST 25), Shangjuxu (ST 37), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) once every other day, 3 times a week. The patients in the PEG group received polyethylene glycol 4000 powder orally, and the pinaverium group received pinaverium bromide tablets orally. All were treated for 6 weeks. The IBS symptom severity score (IBS-SSS) was assessed at baseline, treatment period (2, 4, 6 weeks of treatment) and 12 weeks of follow-up, and the IBS quality of life (IBS-QOL) score was evaluated at the baseline period, 6 weeks of treatment and 12 weeks of follow-up. RESULTS: The total IBS-SSS scores of the two groups of IBS-C patients at 2, 4, 6 weeks of treatment and follow-up of 12 weeks were lower than those in the baseline period ( CONCLUSION Acupuncture with
Acupuncture Points ; Acupuncture Therapy ; Diarrhea ; Humans ; Irritable Bowel Syndrome/therapy* ; Quality of Life ; Treatment Outcome

Acute appendicitis is one of the most common acute abdominal diseases in pediatric surgery.Appendectomy is the standard of care for the treatment of acute appendicitis in children and its curative effect is definite.With the improvement of endoscopic techniques, laparoscopic appendectomy has become a mainstream operation in the recent years.However, individual therapy based on disease progression is attracting more and more attention, which has led to new questions.The management of these questions has not formed consensus at present, such as conclusion timing, operative methods, treatment of appendiceal abscess and effect of non-operative management.This review summarizes the treatment progress of acute appendicitis in children.

Objective: To study the effects of sex, age, length of service, type of work and annual effective radiation dose on nucleoplasmic bridge (NPB) in the peripheral blood lymphocytes of radiation workers. Methods: The peripheral blood samples of 100 radiation workers in Henan province were collected and the NPB in peripheral blood lymphocytes were measured by CBMN assay. The frequencies of NPB formation and NPB-containing cells were calculated, and the effects of various factors on NPB incidence were analyzed statistically. Results: The NPB frequency in radiation workers was higher than that in healthy people (Z=-8.123, P<0.01). Except for sex, the factors of age, length of service, type of work and annual effective dose had significant influences on NPB (χ²= 7.202-45.571, P<0.05). Conclusions NPB reflects the effect of low-dose long-term chronic irradiation on the occupational radiation workers.

Objective To investigate the efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in the treatment of refractory septic shock in children.Methods From January 2016 to December 2018,the clinical data of children with refractory septic shock (RSS) treated by VA-ECMO in Department of Critical Medicine Affiliated Children's Hospital of Shanghai Jiao Tong University were retrospectively analyzed.The patients with refractory septic shock (RSS) treated by VA-ECMO were compared with those with non-refractory septic shock (NRSS).Results There were 8 cases in the RSS-ECMO group and 6 cases in the NRSS-ECMO group.The sex,age,PRISM score,complication showed no significant difference in the two groups.The median time of ECMO in the RSS-ECMO group was 182 (141,216) h,and 5 patients were survived and were discharged from the hospital.The blood lactic acid and vasoactive drug index in the RSS-ECMO group was significantly higher than that in the NRSS-ECMO group (P＜0.05 or P＜0.01).The time of vasoactive drugs use and the ratio of combined continuous renal replacement therapy (CRRT) in the RSS-ECMO group were higher than those in the NRSS-ECMO group,but there was no significant difference (P ＞ 0.05).Atter ECMO establishment,the mean invasive arterial pressure increased significantly at 6 h,and lactic acid decreased significantly at 12 h after ECMO support.SCVO2 returned to normal at 24-h ECMO therapy.Conclusions The success rate of VA-ECMO treatment in children with refractory septic shock complicated with MODS is similar to that of children with non-refractory septic shock.The relationship between ECMO and hemodynamic indexes in sepsis should be further explored.