To investigate the changes in peripheral blood immune cells before and after the onset of septic shock in patients with malignant tumors, and to analyze the relationship between these immune cells and patient prognosis.

To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

OBJECTIVE To establish a method for simultaneous determination of ceftazidime， avibactam and aztreonam concentrations in human plasma.METHODS Stable-isotope-labeled compounds ceftazidime-D 5 ， avibactam- 13 C 5 and aztreonam- 2 H 6 were used as internal standards. Plasma samples were pretreated by protein precipitation with methanol， followed by nitrogen blowing. A ultra-performance liquid chromatography-tandem mass spectrometry （UPLC-MS/MS） technique was applied to develop a quantitative analytical method for simultaneous measurement of ceftazidime， avibactam and aztreonam in human plasma. An ACQUITY UPLC BEH C 18 column was used as the chromatographic column. Gradient elution was performed with 0.01% formic acid-acetonitrile solution as the mobile phase at a flow rate of 0.3 mL/min. The column temperature was set at 40 ℃， and the injection volume was 5 μL. An electrospray ionization source was operated in both positive and negative ion modes for multiple reaction monitoring. Method validation was carried out according to the Guidelines for Bioanalytical Method Validation contained in volume Ⅳ of the 2020 edition of Chinese Pharmacopoeia .RESULTS The linear ranges of ceftazidime， avibactam and aztreonam were 0.04-200， 0.05-50，0.01-50 μg/mL， respectively， with all correlation coefficients no less than 0.996. The relative error （RE） for accuracy was no more than 12.25% （ n ＝5）， and the RSD for precision was no more than 13.49% （ n ＝5）. The RSD of internal-standard-normalized matrix factors was less than 15.00% （ n ＝6）. The RE in stability tests was lower than 15.00% （ n ＝3）.CONCLUSIONS This study successfully established an UPLC-MS/MS method for simultaneous determination of ceftazidime， avibactam and aztreonam concentrations in human plasma. The method possesses favorable accuracy， precision and stability， and can provide methodological support for therapeutic drug monitoring and individualized medication in patients treated with these three combined drugs.

X-linked adrenoleukodystrophy(X-ALD) is an inherited progressive neurometabolic disorder caused by mutations in the ATP-binding cassette subfamily D member 1(ABCD1) gene. The encoded ALD protein dysfunction leads to the accumulation of very-long-chain fatty acids(VLCFA). X-ALD is classified according to its clinical characteristics into childhood cerebral ALD, adolescent cerebral ALD, adult cerebral ALD, adrenomyeloneuropathy(AMN), pure adrenocortical insufficiency, and an asymptomatic phenotype, all of which can present with a variety of neurologic manifestations. In this study, we retrospectively analyzed the clinical manifestations, laboratory findings, genetic test results, and follow-up data of four patients with X-ALD, and investigated the clinical features and pathogenicity of the identified gene mutations. All four patients initially presented with adrenocortical insufficiency(Addison′s disease) and received glucocorticoid replacement therapy. Subsequently, all developed neurologic signs and symptoms with rapid progression. The final diagnosis was confirmed based on elevated VLCFA levels, brain magnetic resonance imaging(MRI) findings, and genetic analysis. Notably, a deletion mutation in Exon 10 of the ABCD1 gene was identified in one case for the first time. We report four cases of X-ALD presenting with adrenocortical insufficiency as the initial symptom, and briefly review the relevant literature to analyze the relationship between linical phenotypes and genetic loci, aiming to provide a reference for early diagnosis and treatment of the disease, and to reduce the risk of misdiagnosis and missed diagnosis.

Objective To analyze the feasibility of probiotics in delaying the progression of early Alzheimer's disease(AD)based on the changes of brain-gut-microbiota axis factors.Methods A total of 100 patients with early AD who visited Shaoxing 7th People's Hospital from December 2023 to December 2024 were selected and divided into control group(40 cases)and study group(60 cases)based on different treatment methods.The control group was treated with donepezil hydrochloride,while study group was treated with donepezil hydrochloride combined with probiotic preparations.The cognitive function,daily living ability,intestinal flora,and relative expression levels of brain-gut-microbiota axis factors,interleukin(IL)-6,tumor necrosis factor-α(TNF-α),5-hydroxytryptamine(5-HT),γ-aminobutyric acid(GABA),and lipopolysaccharide(LPS)/Toll-like receptor 4(TLR4)/nuclear factor-KB(NF-κB)axis factors were compared before and after treatment in both groups.The clinical efficacy and prognosis monitoring results were also compared.Results The total effective rate and the proportion of patients with a clinical dementia rating score of 0 in study group were higher than those in control group(P＜0.05).The cognitive function and daily living ability scores in study group were higher than those in control group(P＜0.05).The copy numbers of lactobacillus and bifidobacterium in study group were higher than those in control group,while the copy numbers of enterococcus and escherichia coli were lower(P＜0.05).The relative expression levels of amyloid-β protein 1-42,IL-6,TNF-α,TLR4,and NF-κB in study group were lower than those in control group,and the levels of 5-HT and GABA were higher(P＜0.05).Conclusion Probiotics can delay the progression of early AD patients and improve clinical efficacy.It is speculated that the mechanism of action may be related to regulating the brain-gut-microbiota axis-mediated LPS/TLR4/NF-κB pathway to restore the intestinal microecology and alleviate neurological inflammation.

Objective : To identify autophagy-related genes involved in pulmonary infection caused by the highly drug-resistant and virulent methicillin-resistant Staphylococcus aureus strain USA300 ( USA300) ，and to explore the underlying molecular mechanisms ， thereby providing potential targets for immunotherapy． Methods: The GSE220943 dataset of a USA300-induced pulmonary infection mouse model was obtained from the GEO database． Differentially expressed genes ( DEGs ) were identified using the DESeq2 package． Autophagy-related genes ( ARGs) were retrieved from the MSigDB and Autophagy databases．Weighted gene co-expression network analysis ( WGCNA) was performed to construct gene co-expression modules．Genes overlapping among DEGs，ARGs，and WGCNA modules were identified as autophagy-related DEGs．Gene Ontology ( GO) enrichment analysis was con- ducted using the clusterProfiler R package，while Kyoto Encyclopedia of Genes and Genomes ( KEGG) pathway en- richment analysis was performed via the Metascape platform．Immune cell infiltration was analyzed using the Immu- CellAI-mouse website．A protein - protein interaction ( PPI) network was constructed using the STRING database， and hub genes were identified through topological analysis in Cytoscape． Receiver operating characteristic curve ( ROC) curves were plotted via the website https: / /www．bioinformatics．com．cn． Finally，key gene expression was validated in mouse lung tissues by real-time quantitative reverse transcription PCR ( RT-qPCR) ． Results: A total of 6 135，4 075，3 680，and 2 342 differentially expressed genes ( DEGs) were identified at 12，24，48，and 96 hours post-infection，respectively．By integrating DEGs，autophagy-related genes ( ARGs) ，and WGCNA mod- ules，19 autophagy-related DEGs were identified． GO and KEGG enrichment analyses indicated that these genes were mainly involved in CD4 + T cell activation and regulation，innate immune responses，and autophagosome mem- brane formation．Immune infiltration analysis revealed that innate immune cells such as neutrophils and dendritic cells predominated during the early phase of infection，while γδ T cells and M2 macrophages became more promi- nent in the later stages．PPI network analysis identified 12 hub autophagy-related genes，among which three upreg- ulated key genes ( Eif2ak2，Ikbke，and Nfkbiz) were further confirmed．The area under the ROC curve for all three genes was 1. 000．RT-qPCR validation demonstrated significantly elevated expression of these three genes in lung tissues at 24 hours post-infection ( all P＜0. 05) ． Conclusion Eif2ak2，Ikbke，and Nfkbiz may be involved in the pulmonary infection caused by USA300 by promoting autophagy and hold promise as potential targets for immuno- therapy．

Objective:To construct a humanistic care nursing program for adult ICU patients, providing guidance for the clinical practice of humanistic care in ICUs.Methods:Based on a literature review and clinical practice experience, a preliminary humanistic care nursing program for adult ICU patients was drafted. From August to September 2024, the Delphi method was used to conduct two rounds of expert consultation with 16 experts to revise the content of each item and the overall program, resulting in the final version of the humanistic care nursing program for ICU adult patients. The experts' engagement was measured by the effective response rate of the questionnaires, their authority by the expert authority coefficient, and the coordination of expert opinions by the Kendall's coefficient of concordance.Results:The effective response rate for the Delphi expert consultation questionnaires was 100.00% (16/16) in both rounds. The expert authority coefficients were 0.872 and 0.875, respectively. After the second round of consultation, the Kendall's coefficients for the importance, applicability, and feasibility of each level of item ranged from 0.119 to 0.313 ( P<0.05). The final humanistic care nursing program for adult ICU patients included three first-level items, 12 second-level items, and 55 third-level items. Conclusions:The humanistic care nursing program for adult ICU patients constructed in this study is scientific, targeted, and feasible, providing guidance for the clinical practice of humanistic care in ICU settings.

Objective:To construct a training program for expert patients with type 2 diabetes mellitus (T2DM), so as to provide reference for T2DM education and management.Methods:Guided by the iceberg quality model, a preliminary training program was developed based on literature analysis and qualitative interviews. Using convenience sampling method, 22 experts were selected for two rounds of Delphi expert consultation from March to April 2024, and the final draft of the training program was discussed and revised based on the experts' opinions.Results:In the two rounds of expert consultation, the effective response rates of the questionnaire were 100.00% (22/22) and 95.45% (21/22), respectively, and the authority coefficient of the experts was all 0.905. The Kendall harmony coefficients ranged from 0.110 to 0.293 and 0.139 to 0.301, respectively ( P<0.05). The finalized training program included five modules of training content, assessment evaluation, training instructors, training time, and training forms. Conclusions:The constructed training program for expert patients with T2DM is scientific, reliable, and comprehensive, which can provide guidance for the next step of T2DM expert patient training.

Objective To investigate the predictive value of pan-immune-inflammation value(PIV),blood urea nitrogen to albumin ratio(BAR),collateral circulation and National Institutes of Health stroke scale(NIHSS)score for disease progression and short-term prognosis in patients with acute perforating artery cerebral infarction(APACI).Methods Patients with APACI admitted to the Neurology Department of Anhui NO.2 Provincial People's Hospital from January 2019 to October 2024 were retrospectively enrolled in this study.General and clinical data,including age,gender,previous history(hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation),smoking history,drinking history,NIHSS scores at admission were collected.Fasting venous blood samples were collected from the patients within 24 h after admission to detect levels of neutrophils,lymphocytes,monocytes,platelets,blood urea nitrogen,and serum albumin.PIV(PIV=neutrophils × platelets × monocytes/lymphocytes)and BAR were calculated.The location of lesions and Fazekas classification of white matter lesions were evaluated using head MRI and MR angiography at admission.Collateral circulation status was assessed based on CT angiography upon admission.Disease progression was defined through comparing the NIHSS score at 72-hour after admission to the score at admission(an increase of 2 or more points in NIHSS score indicating disease progression).The patients were divided into a progression group and a non-progression group based on the increase in NIHSS score,as aforementioned.Patients follow-up was conducted through phone call or outpatient visits at 90 d after discharge.The modified Rankin scale(mRS)was used to evaluate the prognosis,with a mRS score of 0-2 indicates good prognosis,and a 3-6 indicates poor prognosis.Factors with statistically significant differences in univariate analysis were included in a multivariate Logistic regression analysis to explore the influencing factors of disease progression and poor prognosis in patients with APACI.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each indicator for disease progression and poor prognosis in patients with APACI.Results A total of 165 patients with APACI were enrolled in this study,including 121 males and 44 females,aged 27-86 years,with an average of(61±11)years.Among all patients enrolled,56 patients were included in the progression group and 109 patients in the non-progression group,124 patients showed good prognosis and 41 patients had poor prognosis.No statistically significant differences were found in age,gender,smoking history,drinking history,hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation,lesion location,and Fazekas classification of white matter lesions between the progression group and the non-progression group(all P＞0.05).While the NIHSS score at admission,proportion of poor collateral circulation,PIV and BAR in the progression group were significantly higher than those in the non-progression group(all P＜0.05).Multivariate Logistic regression analysis showed that high NIHSS score at admission(OR,1.177,95％CI 1.001-1.384,P=0.049),poor collateral circulation(OR,3.107,95％CI 1.216-7.939,P=0.018),high PIV(OR,1.006,95％CI 1.003-1.009,P=0.001),and high BAR(OR,1.610 × 109,95％CI 5.769 × 104-4.494 × 1013,P＜0.01)were independent risk factors of disease progression in patients with APACI.ROC curve analysis results showed that the area under the curve(AUC)of combination of PIV,BAR,collateral circulation and NIHSS score at admission for predicting disease progression in patients with APACI was 0.914(95％ CI0.861-0.952,P＜0.01),which was greater than that of each indicator(all P＜0.05).No statistically significant differences were found in smoking,drinking,hypertension,hyperlipidemia,coronary heart disease,atrial fibrillation,lesion location,and BAR between the poor prognosis and the good prognosis group(all P＞0.05).Compared with the good prognosis group,the poor prognosis group had significantly older age and higher proportion of patients with diabetes,NIHSS score at admission,proportion of patients with poor collateral circulation,and PIV(all P＜0.05).Moreover,the proportion of men in the poor prognosis group was lower than that in the good prognosis group(P=0.039).There was a statistically significant difference between the good prognosis group and the poor prognosis group in the Fazekas classification of white matter lesions(P＜0.01).Multivariate Logistic regression analysis showed that high NIHSS score at admission(OR,1.345,95％CI 1.081-1.674,P=0.008),poor collateral circulation(OR,3.903,95％CI 1.061-14.355,P=0.040),and high PIV(OR,1.011,95％CI 1.005-1.017,P＜0.01)were independent risk factors of poor prognosis in patients with APACI.The AUC for predicting poor prognosis in patients with APACI through combining PIV,collateral circulation and NIHSS score at admission was 0.911(95％CI 0.857-0.950,P＜0.01),which is greater than using poor collateral circulation or NIHSS score at admission alone(both P＜0.05).However,there was no statistically significant difference in AUC between the PIV,collateral circulation and NIHSS score combined predictive model and the PIV(alone)predictive model(P＞0.05).Conclusions High PIV,high BAR,poor collateral circulation,and high NIHSS score at admission were independent risk factors of disease progression in patients with APACI.Combination of these four indices demonstrates relatively high predictive value for disease progression.In addition,high PIV,poor collateral circulation,and high NIHSS score at admission are independent risk factors of poor prognosis in patients with APACI.Joint detection of the three indices may assist in short-term prognosis evaluation of patients with APACI.

Objective To investigate the clinical effect of Sansheng Decoction combined with Chinese herbal medicine fumigation on patients with lumbar disc herniation after percutaneous endoscopic lumbar discectomy(PELD).Methods Sixty-six patients with lumbar disc herniation of liver and kidney deficiency complicated with blood-stasis syndrome who were planning to take PELD were randomly divided into control group and treatment group,33 cases in each group.Both groups were treated with PELD.After PELD,the control group was routinely treated with anti-inflammatory,analgesic,neurotrophic and anti-infective treatment.On the basis of treatment for the control group,the treatment group was treated with modified Sansheng Decoction(composed of Eucommiae Cortex,Atractylodis Macrocephalae Rhizoma,Corni Fructus,Notoginseng Radix et Rhizoma,Acanthopanacis Cortex,etc.)orally combined with Chinese herbal medicine fumigation(consists of Achyranthis Bidentatae Radix,Angelicae Sinensis Radix,Spatholobi Caulis,Taxilli Herba,Kadsurae Coccineae Radix,etc.).Before and after treatment,the changes of Visual Analogue Scale(VAS)score of lumbar pain,Japanese Orthopedic Association(JOA)score and Oswestry Disability Index(ODI)score of lumbar function in the two groups were observed.Moreover,the postoperative complications and recurrence in the two groups were compared.Results(1)After 1 month,3 months and 6 months of treatment,except that there was no significant difference between the post-6-month VAS scores and the post-3-month VAS scores in the control group(P＞0.05),the VAS scores of lumbar pain in the two groups were all significantly lowered compared with those at the previous observation time point(P＜0.05),and the decrease in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P＜0.05 or P＜0.01).(2)After 1 month,3 months and 6 months of treatment,except that the JOA scores of lumbar function in the control group after 6 months of treatment did not differ from those after 3 months of treatment(P＞0.05),the JOA scores of the two groups were all significantly increased compared with those at the previous observation time point(P＜0.05),and the increase in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P＜0.01).(3)After 1 month,3 months and 6 months of treatment,the ODI score of lumbar function in the two groups were all significantly decreased compared with those at the previous observation time point(P＜0.05),and the decrease in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P＜0.01).(4)In terms of the complications,no injury of nerve root and dura mater or other adverse reactions occurred in the two groups after operation.(5)During the trial,there was one patient lost from each group,and the remaining patients were followed up for 3 years.Within the 3 years,4 patients in the control group relapsed,and one patient in the treatment group relapsed,and all of the relapsed patients did not receive reoperation.Conclusion Sansheng Decoction combined with Chinese herbal medicine fumigation exerts certain effect in the treatment of patients with liver and kidney deficiency complicated with blood-stasis syndrome after PELD for lumbar disc herniation.The therapy can effectively relieve postoperative pain and promote the recovery of postoperative lumbar function.