ObjectiveTo investigate the triglyceride-glucose (TyG) index and the level of serum homocysteine (Hcy) in association with the incidence of stroke in type 2 diabetes mellitus (T2DM) patients. MethodsBased on the chronic disease risk factor surveillance cohort in Pudong New Area, Shanghai, excluding those with stroke in baseline survey, T2DM patients who joined the cohort from January 2016 to October 2020 were selected as the research subjects. During the follow-up period, a total of 318 new-onset ischemic stroke patients were selected as the case group, and a total of 318 individuals matched by gender without stroke were selected as the control group. The Cox proportional hazards regression model was used to adjust for confounding factors and explore the serum TyG index and the Hcy biochemical indicator in association with the risk of stroke. ResultsThe Cox proportional hazards regression results showed that after adjusting for confounding factors, the risk of stroke in T2DM patients with 10 μmol·L⁻¹-¹ and Hcy>15 μmol·L⁻¹ was 1.532 times (95%CI: 1.017‒2.309 times, P=0.041) and 1.738 times (95%CI: 1.119‒2.699 times, P=0.014) higher respectively, compared to T2DM patients with Hcy≤10 μmol·L⁻¹. T2DM patients with TyG>9.074 had 1.396 times higher risk of stroke (95%CI: 1.091‒1.787, P=0.008) compared to those with TyG≤9.074. The study found that urea and α1-antitrypsin (α1-AT) were independent risk factors for the incidence of stroke in T2DM patients. For every unit increase in urea andα1-AT, the risk of stroke in T2DM patients increased by 233.6% (HR=3.336, 95%CI: 1.588‒7.009, P=0.001) and 11.3% (HR=1.113, 95%CI: 1.028‒1.205, P=0.008), respectively. Cumulative risk curves showed that Hcy>10 μmol·L⁻¹ and TyG>9.074 accelerated the time to stroke occurrence in T2DM patients. ConclusionElevated levels of Hcy>10 μmol·L⁻¹ and a higher TyG index are risk factors for stroke in T2DM patients. Effective interventions for Hcy and TyG should be conducted for diabetic patients to reduce the incidence of stroke.

Objective This study aims to develop and validate a dynamic web-based nomogram for predicting kinetophobia in patients following percutaneous coronary intervention(PCI).Methods A prospective design was employed to selectively enroll 330 PCI patients admitted to a hospital in Hangzhou from December 2022 to July 2023.Single-factor analysis and Lasso regression were utilized to identify independent risk factors for kinesophobia post-PCI.Logistic regression was performed using R software,and a nomogram was constructed.The model was assessed through the area under the receiver operating characteristic curve(AUC)and Hosmer-Lemeshow tests.Results There were 206 cases of kinesiophobia in 330 patients after PCI,and the incidence was 62.4％.Logistic regression analysis identified combined heart failure,emergency surgery,NYHA cardiac function grade,ADL level,sedentary behavior,Chinese version of PROMIS Physical Function Summary Table score,and Chinese version of Perceptive Social Support Scale score as independent influencing factors for kinesophobia after PCI(P＜0.05).The AUC value of the model was 0.821,with a sensitivity of 70.4％and specificity of 82.0％.The Hosmer-Lemeshow fit test yielded a non-significant result(x2=9.350,P=0.314).Calibration and decision curves demonstrated the model's favorable calibration and clinical practicability.The C-index of the nomogram prediction model was 0.778,0.774,and 0.800,respectively,by 5-fold cross-validation,10-fold cross-validation,and the Bootstrap method.Conclusion The dynamic nomogram model developed in this study effectively predicts kinesophobia in patients after PCI.It provides valuable references and support for clinical staff in early identification of high-risk patients,enabling the formulation of individualized health education strategies and exercise rehabilitation plans.

Objective To investigate the value of electrocardiogra(ECG)P-wave parameters com-bined with serum adiponectin and visfatin(VF)in predicting recurrence of atrial fibrillation(AF)after radiofrequency ablation.Methods A total of 120 AF patients(AF group)admitted to our hospital from March 2021 to March 2023 were enrolled,and divided into a recurrence group(39 cases)and a non-recurrence group(81 cases)according to the postoperative condition.Another 120 healthy individuals who took physical examination in the same period were enrolled and served as control group.All subjects underwent ECG.ELISA was used to detect adiponectin and VF levels.Logistic regression analysis was used to identify the influencing factors of postoperative recur-rence in AF patients.ROC curve was plotted to analyze the predictive value of P-wave parameters combined with serum adiponectin and VF for postoperative recurrence in AF patients.The P-wave parameters included P-wave duration(PWD),maximum PWD(Pmax),minimum PWD,and P-wave dispersion(Pd).Results PWD,Pmax and Pd were significantly decreased in AF patients after operation(P＜0.01).Serum adiponectin level was obviously lower and that of VF was nota-bly higher in the AF group than the control group(6.15±1.58 μg/L vs 11.43±2.26 μg/L,12.05±2.30 μg/L vs 6.23±1.02 μg/L,P＜0.01).The recurrence group had remarkably higher preopera-tive PWD,Pmax and Pd,and lower adiponectin and higher VF levels than the non-recurrence group(P＜0.01).Multivariate logistic regression analysis showed that PWD,Pmax,Pd,and VF were risk factors,and adiponectin was a protective factor for postoperative recurrence in AF pa-tients(P＜0.05,P＜0.01).ROC curve analysis indicated that PWD,Pmax,Pd,adiponectin and VF combined together to detect postoperative recurrence in AF patients had an AUC value of 0.972,which was higher than that of above indicators alone(Z=2.574,Z=2.567,Z=2.543,Z=2.554,Z=2.586,P＜0.05).Conclusion ECG P-wave parameters as well as elevated serum VF and re-duced serum adiponectin are influencing factors for postoperative recurrence in AF patients,and their combined detection may promote the predictive value for postoperative recurrence in them.

Objective To analyze the relationship between group B streptococcus(GBS)infection,vaginal microecological changes and adverse pregnancy outcomes of pregnant women.Methods The data of 202 pregnant women with GBS infection(the positive group)and 202 pregnant women without GBS infection(the negative group)in the third trimester of pregnancy were collected.The general data,vaginal microecology and adverse pregnancy outcomes were compared between the two groups.According to the results of vaginal microecological examination,patients in the two groups were divided into the positive normal group(76 cases),the positive imbalance group(126 cases),the negative normal group(154 cases)and the negative imbalance group(48 cases).Pregnant women in the positive group were treated with antibiotics immediately after premature rupture of membranes,and pregnant women without premature rupture of membranes were treated with antibiotics after labor.Pregnant women with trichomonas vaginitis or fungal vaginitis or bacterial vaginosis were given nifuratel nystatin vaginal soft capsules for treatment.The adverse pregnancy outcomes were compared between the four groups.Results Compared with the negative group,the proportion of gestational diabetes mellitus,proportion of pH value＞4.5,detection rates of mycotic vaginitis and bacterial vaginosis,premature delivery rate,premature membrane rupture rate,postpartum hemorrhage rate and fetal intrauterine distress rate were higher in the positive group(P＜0.05).The premature delivery rate,premature membrane rupture rate,puerperal infection rate and fetal intrauterine distress rate were higher in the negative imbalance group than those in the negative normal group(P＜0.05),and the positive imbalance group had higher premature delivery rate,premature membrane rupture rate,postpartum hemorrhage rate,puerperal infection rate,fetal intrauterine distress rate,intrauterine infection rate and neonatal infection rate(P＜0.05).Compared with the negative imbalance group,the premature delivery rate,premature membrane rupture rate and fetal intrauterine distress rate were lower in the positive normal group,and those were higher in the positive imbalance group(P＜0.05).The positive imbalance group had higher rates of premature delivery,premature membrane rupture and fetal intrauterine distress compared to the positive normal group(P＜0.05).Conclusion GBS infection in the third trimester of pregnancy increases the incidence of adverse pregnancy outcomes,and vaginal microecological imbalance its synergies promote of adverse pregnancy outcomes.

Objective To investigate the expression of CD123 in children with acute lymphoblastic leukemia(ALL)and its effect on the clinical characteristics and prognosis of children with B-lineage acute lymphoblastic leukemia(B-ALL).Methods A retrospective analysis was conducted on the clinical data of 251 children with ALL who were admitted to the Department of Hematology and Oncology,Children's Hospital of Kunming Medical University,from December 2019 to June 2022.According to the expression of CD123 at initial diagnosis,the children were divided into CD123+group and CD123-group,and the two groups were compared in terms of clinical characteristics and treatment outcome.The factors influencing the prognosis were analyzed.Results Among the 251 children with ALL,there were 146 children(58.2%)in the CD123+group.The B-ALL group had a significantly higher positive expression rate of CD123 than the acute T lymphocyte leukemia group(P<0.05).Compared with the CD123-group,the CD123+group had significantly lower peripheral blood leukocyte count and percentage of juvenile cells and a significantly higher proportion of children with high hyperdiploid karyotype or an age of 1-10 years,with a relatively low proportion of children with E2A-PBX1 fusion gene(P<0.05).The multivariate Cox proportional-hazards regression model analysis showed that compared with the>10 years group,the 1-10 years group had a significantly higher overall survival rate(P<0.05),and compared with the high risk group,the moderate risk group had a significantly higher event-free survival rate in children with B-ALL(P<0.05).Conclusions CD123 is widely expressed in children with B-ALL,and positive expression of CD123 might be an indicator for good prognosis in children with B-ALL,which is of great significance for evaluating the efficacy of remission induction therapy and survival prognosis of children with B-ALL.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

italic>Anoectochilus roxburghii liquid (spray, a hospital preparation of Wu Mengchao Hepatobiliary Hospital of Fujian Medical University) has shown a good clinical treatment effect during the COVID-19 pandemic, but its material basis and mechanism of action are still unclear. In this study, network pharmacology and molecular docking methods were used to predict the molecular mechanism of A. roxburghii liquid against COVID-19, and pharmacodynamic experiments in vitro were conducted to study the interaction between the current targets with clear preventive and therapeutic effects and the key components of A. roxburghii liquid. UPLC-MS and database were used to compare and analyze the active ingredients in the liquid, and 17 potential active ingredients with good drug-like properties were screened by in vivo pharmacokinetics process in SwissADME database. SwissTargetPrediction and GeneCards were searched to find 93 common targets. Cytoscape 3.8.2 software was used to construct the "component-target" network map, and the Metascape platform was used for gene function annotation and pathway enrichment analysis. It was found that the extract could regulate the positive response to external stimuli, inflammatory response, cytokine production and other biological processes by binding the active ingredients such as isorhamnetin, kaempferol, luteolin, quercetin and apigenin to the common targets (NOS3, MPO, MMP3, etc.), and play an anti-COVID-19 role. In the angiotensin-converting enzyme 2 (ACE2) activity inhibition assay, it was found that the stock solution of A. roxburghii liquid (for spray), and the supernatant after removing polysaccharides (mainly containing flavonoids) could to some extent inhibit the activity of ACE2. Crucially, in the experiment of 2019-nCOV-S pseudovirus infecting HEK-293T-ACE2 cells, we found that A. roxburghii liquid may exert anti-COVID-19 effects by blocking the binding of SARS-CoV-S protein to ACE2.

Based on the strategy of metabolomics combined with bioinformatics, this study analyzed the potential allergens and mechanism of pseudo-allergic reactions (PARs) induced by the combined use of Reduning injection and penicillin G injection. All animal experiments and welfare are in accordance with the requirements of the First Affiliated Experimental Animal Ethics and Animal Welfare Committee of Henan University of Chinese Medicine (approval number: YFYDW2020002). Based on UPLC-Q-TOF/MS technology combined with UNIFI software, a total of 21 compounds were identified in Reduning and penicillin G mixed injection. Based on molecular docking technology, 10 potential allergens with strong binding activity to MrgprX2 agonist sites were further screened. Metabolomics analysis using UPLC-Q-TOF/MS technology revealed that 34 differential metabolites such as arachidonic acid, phosphatidylcholine, phosphatidylserine, prostaglandins, and leukotrienes were endogenous differential metabolites of PARs caused by combined use of Reduning injection and penicillin G injection. Through the analysis of the "potential allergen-target-endogenous differential metabolite" interaction network, the chlorogenic acids (such as chlorogenic acid, neochlorogenic acid, cryptochlorogenic acid, and isochlorogenic acid A) and β-lactam allergens in the combination of the two may be mainly regulated by PLD1, PLA2G12A and CYP1A1. The three upstream signal target proteins mainly activate the arachidonic acid metabolic pathway, promote the degranulation of mast cells, release downstream endogenous inflammatory mediators, and induce PARs.

Objective:To evaluate the clinical value of combined detection of placenta associated 8 (PLAC8) and platelet activating factor acetylhydrolase (PLA2G7) for early identification of sepsis and non-infectious systemic inflammatory response syndrome (SIRS).Methods:A cross-sectional study was conducted. A total of 189 febrile patients suspected infection who were admitted to Huashan Hospital, Fudan University from October 2022 to April 2023 were included. Based on etiological, laboratory test results and clinical data, patients were classified as infection or non-infection, and further classified as sepsis or non-infectious SIRS according to diagnostic criteria. Real-time fluorescence polymerase chain reaction was used to detect the mRNA levels of PLAC8 and PLA2G7 in peripheral venous blood of patients. Hematology, inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin, sepsis-related organ failure assessment (SOFA) score, and the difference of cycle threshold (Ct) values between PLA2G7 and PLAC8 ((PLA2G7-PLAC8)ΔCt value))were compared between the sepsis and non-infectious SIRS groups. Statistical comparison was analyzed using Mann-Whitney U test, and the diagnostic performance of (PLA2G7-PLAC8)ΔCt value in discriminating sepsis from non-infectious SIRS was evaluated using receiver operating characteristic curve. Results:Among the 189 febrile patients suspected infection, there were 80 non-infectious patients, including 51 non-infectious SIRS patients, and 109 infection patients, including 53 sepsis patients. The neutrophil ratio, CRP, IL-6, procalcitonin, and SOFA score of non-infectious SIRS patients were lower than those of the sepsis group, and the differences were all statistically significant ( Z=-2.70, -3.11, -2.16, -3.76 and -2.33, respectively, all P<0.05). The (PLA2G7-PLAC8)ΔCt value in the non-infectious SIRS group was 4.38(1.41), which was lower than 8.18 (6.19) in the sepsis group, with a statistically significant difference ( U=193.50, P<0.001). The area under the receiver operating characteristic curve (AUROC) for (PLA2G7-PLAC8)ΔCt value in the differential diagnosis of sepsis and non-infectious SIRS was 0.859, with the optimal cut-off value of 5.86. The sensitivity and specificity were 82.2% and 71.9%, respectively. When combined with procalcitonin, the AUROC was 0.917, with a sensitivity of 95.6% and specificity of 70.6%. Conclusions:The (PLA2G7-PLAC8)ΔCt value in peripheral blood has good clinical value for early identification of sepsis and non-infectious SIRS, especially when combined with procalcitonin, which could further improve the accuracy of differential diagnosis.

Objective To evaluate the efficacy and safety of brexpiprazole in treating acute schizophrenia.Methods Patients with schizophrenia were randomly divided into treatment group and control group.The treatment group was given brexpiprozole 2-4 mg·d-1 orally and the control group was given aripiprazole 10-20 mg·d-1orally,both were treated for 6 weeks.Clinical efficacy of the two groups,the response rate at endpoint,the changes from baseline to endpoint of Positive and Negative Syndrome Scale(PANSS),Clinical Global Impression-Improvement(CGI-S),Personal and Social Performance scale(PSP),PANSS Positive syndrome subscale,PANSS negative syndrome subscale were compared.The incidence of treatment-related adverse events in two groups were compared.Results There were 184 patients in treatment group and 186 patients in control group.After treatment,the response rates of treatment group and control group were 79.50％(140 cases/184 cases)and 82.40％(150 cases/186 cases),the scores of CGI-I of treatment group and control group were(2.00±1.20)and(1.90±1.01),with no significant difference(all P＞0.05).From baseline to Week 6,the mean change of PANSS total score wese(-30.70±16.96)points in treatment group and(-32.20±17.00)points in control group,with no significant difference(P＞0.05).The changes of CGI-S scores in treatment group and control group were(-2.00±1.27)and(-1.90±1.22)points,PSP scores were(18.80±14.77)and(19.20±14.55)points,PANSS positive syndrome scores were(-10.30±5.93)and(-10.80±5.81)points,PANSS negative syndrome scores were(-6.80±5.98)and(-7.30±5.15)points,with no significant difference(P＞0.05).There was no significant difference in the incidence of treatment-related adverse events between the two group(69.00％vs.64.50％,P＞0.05).Conclusion The non-inferiority of Brexpiprazole to aripiprazole was established,with comparable efficacy and acceptability.