Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

The patient, a 20-day-old male, was admitted due to respiratory distress that had persisted for 20 days after birth. The main clinical manifestations included gradually worsening respiratory distress and edema. The patient received treatment including mechanical ventilation and diuretics. Echocardiography indicated cardiomegaly, pulmonary hypertension, and heart failure. A comprehensive systemic examination revealed a significant blowing vascular murmur upon auscultation over the anterior fontanelle and bilateral temporal regions. Further imaging studies including cranial magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance venography showed marked dilation of the superior sagittal sinus, transverse sinus, and sigmoid sinus, leading to a definitive diagnosis of dural arteriovenous fistula. After a multidisciplinary consultation, the patient underwent cerebral angiography and partial embolization of the left parietal arteriovenous fistula. Postoperatively, the patient was treated with positive inotropes, diuretics, and fluid restriction. Ultimately, the patient was weaned off the ventilator and discharged in improved condition. This article reports a case of neonatal dural arteriovenous fistula presenting with respiratory distress and discusses the multidisciplinary approach to managing this condition, which aids in early disease recognition and guides clinical decision-making.
Humans ; Male ; Infant, Newborn ; Central Nervous System Vascular Malformations/diagnosis* ; Respiratory Distress Syndrome, Newborn/etiology* ; Embolization, Therapeutic

Objective To explore the mechanism of Luzhongjiangu Decoction in treating Osteonecrosis of the femoral head(ONFH).Methods Animal experiments were conducted to validate the therapeutic effect of Luzhongjiangu Decoction on ONFH.Network pharmacology was employed to screen potential targets,and molecular docking was used to verify the affinity between ligands and receptors.Fifty rats were randomly divided into blank group,model group,high-dose Luzhongjiangu Decoction groups,medium-dose Luzhongjiangu Decoction groups and low-dose Luzhongjiangu Decoction groups.After treatment,the therapeutic effect was evaluated by bone histomorphometry,bone histopathology and the expression of osteogenic related proteins.The serum metabolic differences were detected by UHPLC-QE-MS non-targeted metabonomics technique,followed by metabolic pathway enrichment analysis.Network pharmacology and metabolomics were integrated,and molecular docking was employed to further investigate the underlying mechanisms..Results The experimental results showed that Luzhongjiangu Decoction can significantly increase the expression of OCN,OPN and other osteogenic related factors,increase bone mineral density,alleviate the destruction of bone trabeculae,compared with that in the model group(P<0.01).The metabolomics test showed that compared with model group,Luzhongjiangu Decoction could callback 34 kinds of serum metabolic differences,involving 21 metabolic pathways,the main metabolic pathways were arachidonic acid metabolism,steroid hormone biosynthesis,primary bile acid biosynthesis,lysine degradation and so on.Network pharmacological results suggested that 185 active components and 1040 targets,551 disease targets and 76 intersection targets were obtained.The key pathways of Luzhongjiangu Decoction in the treatment of ONFH,which were analyzed by KEGG,involved HIF-1 signaling pathway,thyroid hormone signaling pathway,Calcium signaling pathway and so on.Integrated analysis showed that Luzhongjiangu Decoction may treat ONFH through seven metabolic pathways including arginine and proline metabolism,arachidonic acid metabolism,and steroid hormone biosynthesis;the molecular docking results also revealed correlation between potential pharmacodynamic substances and core target genes.Conclusion Luzhongjiangu Decoction can regulate the balance between proliferation and apoptosis of bone cells in a hypoxic environment by affecting the metabolic pathways such as arachidonic acid metabolism and HIF-1 signaling pathway,thereby exerting a therapeutic effect on osteonecrosis of the femoral head.

Objective:To investigate the water improvement status and current disease situation in drinking water-borne endemic fluorosis areas of Taiyuan City, evaluate the effect of prevention and control measures, and provide a basis for optimizing control measures.Methods:Monitoring data from 2019 to 2024 for drinking water-borne endemic fluorosis in the diseased areas in Taiyuan City were collected from the Taiyuan Center for Disease Control and Prevention. A retrospective analysis was conducted on water improvement status, water fluoride content, dental fluorosis in children aged 8 - 12, skeletal fluorosis, and urinary fluoride monitoring results in all endemic villages.Results:From 2019 to 2024, all endemic villages in the six endemic counties (districts) of Taiyuan City completed water improvement. The number of water improvement projects each year was 75, 75, 72, 68, 64, and 57, respectively, with all projects operating normally. The qualified rates of water fluoride content each year were 81.33% (61/75), 100% (75/75), 98.61% (71/72), 75.00% (51/68), 87.50% (56/64), and 75.44% (43/57), respectively, with statistical significant differences ( χ2 = 36.99, P < 0.001). The detection rates of dental fluorosis each year were 18.19% (600/3 298), 14.42% (530/3 676), 11.14% (435/3 904), 11.13% (421/3 781), 11.59% (435/3 754), and 5.37% (299/5 567), respectively, with statistical significant differences ( χ2 = 386.42, P < 0.001). In 2024, 824 people were screened for skeletal fluorosis, with 250 cases showing positive symptoms and signs. Among the 250 positive cases, 210 underwent X-ray examination, detecting 170 skeletal fluorosis patients, with an X-ray positive rate of 80.95% (170/210) and a skeletal fluorosis detection rate of 20.63% (170/824). Urinary fluoride monitoring results showed that the geometric mean of urinary fluoride in villages with excessive water fluoride content was 2.95 mg/L, which was higher than the normal upper limit (1.60 mg/L). However, there was no statistically significant difference in urinary fluoride levels between skeletal fluorosis patients and non-skeletal fluorosis individuals ( Z = 0.78, P = 0.434). Conclusions:From 2019 to 2024, the drinking water-borne endemic fluorosis areas in Taiyuan City have undergone comprehensive water improvement and the water improvement projects are operating well. The qualified rate of water fluoride content has fluctuated, while the detection rate of dental fluorosis has decreased. Continuous monitoring is needed in the future to implement long-term water improvement measures and strengthen screening and treatment efforts for patients with fluorosis.

A 36-year-old male developed unconsciousness and no response to voice stimuli after taking approximately 2 050 mg felodipine (the specific time was unknown). Two hours later, he was sent to the department of emergency by his family and admitted to the hospital. His vital signs showed body temperature 35.1 ℃, pulse 148 times/min, respiration 32 times/min, and blood pressure 65/34 mmHg. Acute drug poisoning, acute toxic cardiomyopathy, acute toxic shock, acute type Ⅱ respiratory failure, acute toxic encephalopathy, and acute renal failure were diagnosed based on the patient′s clinical manifestations combined with laboratory tests results, cardiac ultrasound, chest and abdominal CT scans. Endotracheal intubation connected to a ventilator for invasive assisted ventilation, pressure boosting, and fluid resuscitation were given. At the same time, repeated gastric lavage and enema were performed to remove toxins. Blood perfusion was intermittently and repeatedly administered, and continuous renal replacement therapy was used. The blood concentration of felodipine was 1 298 μg/L at 2 hours after admission, and cardiac arrest occurred at 4 hours. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) treatment was administered immediately. After 48 hours of ECMO operation, sedatives were discontinued and the patient′s consciousness was improved after 4 hours. On the 5th day of ECMO treatment, his heart rate was 72 beats per minute, and blood pressure was 127/65 mmHg. The blood concentration of felodipine decreased to 2 μg/L. The patient′s vital signs were significantly improved and ECMO supportive treatment was withdrawn. After 26 days of hospitalization, the patient recovered and was discharged.

A 36-year-old male developed unconsciousness and no response to voice stimuli after taking approximately 2 050 mg felodipine (the specific time was unknown). Two hours later, he was sent to the department of emergency by his family and admitted to the hospital. His vital signs showed body temperature 35.1 ℃, pulse 148 times/min, respiration 32 times/min, and blood pressure 65/34 mmHg. Acute drug poisoning, acute toxic cardiomyopathy, acute toxic shock, acute type Ⅱ respiratory failure, acute toxic encephalopathy, and acute renal failure were diagnosed based on the patient′s clinical manifestations combined with laboratory tests results, cardiac ultrasound, chest and abdominal CT scans. Endotracheal intubation connected to a ventilator for invasive assisted ventilation, pressure boosting, and fluid resuscitation were given. At the same time, repeated gastric lavage and enema were performed to remove toxins. Blood perfusion was intermittently and repeatedly administered, and continuous renal replacement therapy was used. The blood concentration of felodipine was 1 298 μg/L at 2 hours after admission, and cardiac arrest occurred at 4 hours. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) treatment was administered immediately. After 48 hours of ECMO operation, sedatives were discontinued and the patient′s consciousness was improved after 4 hours. On the 5th day of ECMO treatment, his heart rate was 72 beats per minute, and blood pressure was 127/65 mmHg. The blood concentration of felodipine decreased to 2 μg/L. The patient′s vital signs were significantly improved and ECMO supportive treatment was withdrawn. After 26 days of hospitalization, the patient recovered and was discharged.

Objective To explore the mechanism of Luzhongjiangu Decoction in treating Osteonecrosis of the femoral head(ONFH).Methods Animal experiments were conducted to validate the therapeutic effect of Luzhongjiangu Decoction on ONFH.Network pharmacology was employed to screen potential targets,and molecular docking was used to verify the affinity between ligands and receptors.Fifty rats were randomly divided into blank group,model group,high-dose Luzhongjiangu Decoction groups,medium-dose Luzhongjiangu Decoction groups and low-dose Luzhongjiangu Decoction groups.After treatment,the therapeutic effect was evaluated by bone histomorphometry,bone histopathology and the expression of osteogenic related proteins.The serum metabolic differences were detected by UHPLC-QE-MS non-targeted metabonomics technique,followed by metabolic pathway enrichment analysis.Network pharmacology and metabolomics were integrated,and molecular docking was employed to further investigate the underlying mechanisms..Results The experimental results showed that Luzhongjiangu Decoction can significantly increase the expression of OCN,OPN and other osteogenic related factors,increase bone mineral density,alleviate the destruction of bone trabeculae,compared with that in the model group(P<0.01).The metabolomics test showed that compared with model group,Luzhongjiangu Decoction could callback 34 kinds of serum metabolic differences,involving 21 metabolic pathways,the main metabolic pathways were arachidonic acid metabolism,steroid hormone biosynthesis,primary bile acid biosynthesis,lysine degradation and so on.Network pharmacological results suggested that 185 active components and 1040 targets,551 disease targets and 76 intersection targets were obtained.The key pathways of Luzhongjiangu Decoction in the treatment of ONFH,which were analyzed by KEGG,involved HIF-1 signaling pathway,thyroid hormone signaling pathway,Calcium signaling pathway and so on.Integrated analysis showed that Luzhongjiangu Decoction may treat ONFH through seven metabolic pathways including arginine and proline metabolism,arachidonic acid metabolism,and steroid hormone biosynthesis;the molecular docking results also revealed correlation between potential pharmacodynamic substances and core target genes.Conclusion Luzhongjiangu Decoction can regulate the balance between proliferation and apoptosis of bone cells in a hypoxic environment by affecting the metabolic pathways such as arachidonic acid metabolism and HIF-1 signaling pathway,thereby exerting a therapeutic effect on osteonecrosis of the femoral head.

Objective:To investigate the water improvement status and current disease situation in drinking water-borne endemic fluorosis areas of Taiyuan City, evaluate the effect of prevention and control measures, and provide a basis for optimizing control measures.Methods:Monitoring data from 2019 to 2024 for drinking water-borne endemic fluorosis in the diseased areas in Taiyuan City were collected from the Taiyuan Center for Disease Control and Prevention. A retrospective analysis was conducted on water improvement status, water fluoride content, dental fluorosis in children aged 8 - 12, skeletal fluorosis, and urinary fluoride monitoring results in all endemic villages.Results:From 2019 to 2024, all endemic villages in the six endemic counties (districts) of Taiyuan City completed water improvement. The number of water improvement projects each year was 75, 75, 72, 68, 64, and 57, respectively, with all projects operating normally. The qualified rates of water fluoride content each year were 81.33% (61/75), 100% (75/75), 98.61% (71/72), 75.00% (51/68), 87.50% (56/64), and 75.44% (43/57), respectively, with statistical significant differences ( χ2 = 36.99, P < 0.001). The detection rates of dental fluorosis each year were 18.19% (600/3 298), 14.42% (530/3 676), 11.14% (435/3 904), 11.13% (421/3 781), 11.59% (435/3 754), and 5.37% (299/5 567), respectively, with statistical significant differences ( χ2 = 386.42, P < 0.001). In 2024, 824 people were screened for skeletal fluorosis, with 250 cases showing positive symptoms and signs. Among the 250 positive cases, 210 underwent X-ray examination, detecting 170 skeletal fluorosis patients, with an X-ray positive rate of 80.95% (170/210) and a skeletal fluorosis detection rate of 20.63% (170/824). Urinary fluoride monitoring results showed that the geometric mean of urinary fluoride in villages with excessive water fluoride content was 2.95 mg/L, which was higher than the normal upper limit (1.60 mg/L). However, there was no statistically significant difference in urinary fluoride levels between skeletal fluorosis patients and non-skeletal fluorosis individuals ( Z = 0.78, P = 0.434). Conclusions:From 2019 to 2024, the drinking water-borne endemic fluorosis areas in Taiyuan City have undergone comprehensive water improvement and the water improvement projects are operating well. The qualified rate of water fluoride content has fluctuated, while the detection rate of dental fluorosis has decreased. Continuous monitoring is needed in the future to implement long-term water improvement measures and strengthen screening and treatment efforts for patients with fluorosis.

BACKGROUND:Osteonecrosis of the femoral head is a common and disabling disease,which is mainly characterized by microcirculation disorders and bone cell metabolism disorders.Luzhongjiangu decoction was developed by Shandong Academy of Chinese Medicine and used in the form of soup in the clinic,which has good efficacy in the treatment of osteonecrosis of the femoral head.However,its mechanism of action has not been clarified. OBJECTIVE:To study the effect mechanism of Luzhongjiangu decoction on intestinal flora in rats with osteonecrosis of the femoral head based on 16S rDNA sequencing technique. METHODS:The model of osteonecrosis of the femoral head was established in Wistar rats by intragastric administration of retinoic acid.The therapeutic effect of Luzhongjiangu decoction was evaluated by serum hormone,bone histopathology and serum hormone levels.16s rDNA sequencing technique was used to detect the intestinal flora of rats in the blank control group,model group and middle-dose Luzhongjiangu decoction group.The corresponding library was constructed and OTU clustering and microbial community diversity and abundance analysis were carried out to determine the composition of intestinal flora and the changes of species and diversity among groups. RESULTS AND CONCLUSION:Luzhongjiangu decoction could significantly increase the expression of osteocalcin,osteopontin and other osteogenic related factors,alleviate the destruction of bone trabeculae,increase bone mineral density,and had a significant therapeutic effect on osteonecrosis of the femoral head,of which the middle dose group showed the most significant effect.The results of intestinal flora sequencing showed that Luzhongjiangu decoction improved the flora disorder of rats with osteonecrosis of the femoral head to some extent,and screened out different colonies such as Bacillus,Desulfurizans,Desulfurization,Isobacteria,Bifidobacterium and so on;it could up-regulate the abundance of beneficial bacteria such as Bifidobacterium,down-regulate the abundance of harmful bacteria such as Desulfovibrio,and improve the structure of intestinal flora.Functional prediction analysis indicated that Luzhongjiangu decoction could mainly affect amino acid metabolism and energy metabolism.Correlation analysis showed that the differential bacteria of Bifidobacterium and Intestinimonas in the middle dose group of Luzhongjiangu decoction were positively correlated with vitamin D3,estradiol and calcitonin,and negatively correlated with prostaglandin E2.In the model group,Escherichia-Shigella,Desulfovibrio,Globicatella and Streptococcus were positively correlated with prostaglandin E2 and negatively correlated with vitamin D3,estradiol and calcitonin.To conclude,Luzhongjiangu decoction may play a role in the treatment of osteonecrosis of the femoral head by regulating the structure of intestinal flora,up-regulating the abundance of beneficial bacteria and affecting the secretion of vitamin D3,estradiol,calcitonin and prostaglandin E2.

Objective To observe the effects of electroacupuncture on intestinal flora and serum inflammatory factors in rabbit model with rheumatoid arthritis(RA);To explore the mechanism of its therapeutic effect on RA.Methods RA model rabbits were established by ovalbumin induction combined with Freund's complete adjuvant,and the rabbits after successful modeling were randomly divided into model group,probiotic group and electroacupuncture group,with 6 rabbits in each group.Another 6 rabbits were set as the normal group.The electroacupuncture group received electroacupuncture at the bilateral"Zusanli"and"Dubi"for 30 minutes,the probiotic group was given probiotic capsules solution(14.5 mg/kg)by gavage,once a day,for two consecutive weeks.The knee joint circumference and pain threshold of rabbits were measured,histopathological morphological changes of colonic tissue and synovial tissue ws observed by HE staining,16S rDNA sequencing was used to analyze structural changes of intestinal flora,the contents of TNF-α,IL-1β and IL-6 in serum were detected by ELISA.Results Compared with the normal group,the circumference of knee joint of rabbits in the model group increased significantly,the pain threshold was significantly decreased(P<0.01);the colonic mucosal damage was serious,the goblet cells were missing,a large number of inflammatory cells were infiltrate;the joint capsule synovial surface was rough,the synovial cell layer was hyperplasia and thickening,the synovial tissue inflammatory cell infiltration was obvious;the number and evenness of gut microbiota species decreased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes decreased(P<0.05,P<0.01),the relative abundance of Desulfobacteria increased(P<0.01),while the relative abundance of Campylobacter,Lawsonella,and Pseudomonas increased(P<0.01),while the relative abundance of Heshanomonas and Herbaspirillum decreased(P<0.01);the contents of serum TNF-α,IL-1β and IL-6 increased(P<0.01).Compared with the model group,the knee joint circumference of the probiotic group and the electroacupuncture group decreased,the pain threshold increased(P<0.01,P<0.05);the degree of intestinal mucosal damage was reduced,the goblet cells were basically arranged neatly,the inflammatory cell infiltration was reduced;synovial cells proliferation and thickening decreased,with a small amount of inflammatory cell infiltration;the number and evenness of gut microbiota species increased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes increased(P<0.05,P<0.01),the relative abundance of Desulfobacteria decreased(P<0.01),while the relative abundance of Campylobacter,Lawsonella and Pseudomonas decreased(P<0.01),the relative abundance of Heshanomonas and Herbaspirillum increased(P<0.05,P<0.01);the contents of serum TNF-α,IL-1β and IL-6 significantly decreased(P<0.01).Conclusion Electroacupuncture can significantly improve the symptoms of RA rabbits and reduce the inflammatory reaction in synovial tissue of joint,and the mechanism may be related to the regulation of intestinal flora structure.