Objective:To establish a quality control method for the standard decoction of Polygoni Avicularis Herba.Methods:Totally 12 batches of decoction pieces from different origins were collected, the standard decoction was prepared and the quality evaluation method was established, the content of index components in the decoction pieces and the standard decoction was determined with HPLC, the index components, solution pH and other parameters were calculated, and the similarity analysis was carried out against the fingerprints.Results:The total content of myricetin in 12 batches of decoction pieces was >0.12%, and the content of myricetin in the standard decoction was >0.03%, which met the standard of the 2020 edition of the Chinese Pharmacopoeia. The pH value was 5.1-5.5, the transfer rate of myricetin components ranged from 50.0%-106.3%, and the fingerprint study showed that there were 7 common peaks. The similarity analysis results indicated that the standard decoction of 12 batches of decoction pieces of Polygoni Avicularis Herba had good consistency.Conclusion:The preparation process is stable and feasible in line with the traditional decoction preparation method, and can be used for the research and quality evaluation of the standard decoction.

Strategic management of tributary veins including concomitant versus staged intervention during endovenous thermal ablation for truncal varicose veins remains debated. Concomitant procedures mainly involves thermal ablation with ultrasound-guided foam sclerotherapy or phlebectomy. Staged strategies include initial truncal ablation followed by deliberated tributary management. Major venous disease guidelines exhibit substantial divergence,Japanese Society of Phlebology guidelines in 2019 contraindicate concomitant procedures, European Society for Vascular Surgery 2022 Clinical Practice Guidelines and Chinese frameworks endorse individualized decision-making,while American Vein and Lymphatic Society guidelines in 2023 prioritize concomitant procedures. Systematic literature review reveals that concomitant procedures do not uniformly translate into reduced reintervention rates or improved early Venous Clinical Severity Scores, yet consistently incur elevated complication risks and postoperative pain. Conversely, staged strategies offer superior tolerability with minimized complications. Hemodynamic principles indicate that most competent tributaries undergo partial or complete regression within 6 weeks to 6 months post-ablation and hemodynamic studies demonstrate that staged approaches preserve the drainage function of tributaries, preventing edema in their respective drainage territories and reducing tributary intervention rates. Future multicenter randomized controlled trials are imperative to delineate comparative outcomes between concomitant and staged management of truncal and tributary veins.

Objective To develop a graded early mobility implementation pathway for critically ill adult patients in tertiary hospitals in Beijing and to preliminarily validate its feasibility and effectiveness.Methods Based on the"goal-directed"early mobility concept,a graded early mobility implementation pathway for critically ill patients was developed through evidence synthesis and the Delphi method,consisting of 3 components:patient inclusion,mobility implementation,and mobility evaluation.Using convenience sampling,patients meeting inclusion criteria in the general ICU of a tertiary hospital in Beijing from October 2024 to January 2025 were selected as participants.Among them,25 patients admitted from December 2024 to January 2025 were assigned to an experimental group and received early mobility interventions following the developed pathway.25 patients admitted from October to November 2024 served as a control group and received routine ICU mobility care.Outcomes including diaphragm excursion,muscle strength,ICU length of stay,and adverse events were compared between the 2 groups.Results The graded early mobility pathway achieved an implementation rate of 70.05％in the experimental group,significantly higher than it in the control group(P＜0.001),without increasing adverse events.Post-intervention diaphragm excursion in the experimental group was significantly greater than that in the control group(P=0.018).Conclusion The developed graded early mobility implementation pathway for ICU patients demonstrates scientific rigor and clinical practicality.It provides a reference for the widespread and effective implementation of early mobility in ICUs,standardizing its clinical application.

Objective To develop a graded early mobility implementation pathway for critically ill adult patients in tertiary hospitals in Beijing and to preliminarily validate its feasibility and effectiveness.Methods Based on the"goal-directed"early mobility concept,a graded early mobility implementation pathway for critically ill patients was developed through evidence synthesis and the Delphi method,consisting of 3 components:patient inclusion,mobility implementation,and mobility evaluation.Using convenience sampling,patients meeting inclusion criteria in the general ICU of a tertiary hospital in Beijing from October 2024 to January 2025 were selected as participants.Among them,25 patients admitted from December 2024 to January 2025 were assigned to an experimental group and received early mobility interventions following the developed pathway.25 patients admitted from October to November 2024 served as a control group and received routine ICU mobility care.Outcomes including diaphragm excursion,muscle strength,ICU length of stay,and adverse events were compared between the 2 groups.Results The graded early mobility pathway achieved an implementation rate of 70.05％in the experimental group,significantly higher than it in the control group(P＜0.001),without increasing adverse events.Post-intervention diaphragm excursion in the experimental group was significantly greater than that in the control group(P=0.018).Conclusion The developed graded early mobility implementation pathway for ICU patients demonstrates scientific rigor and clinical practicality.It provides a reference for the widespread and effective implementation of early mobility in ICUs,standardizing its clinical application.

Strategic management of tributary veins including concomitant versus staged intervention during endovenous thermal ablation for truncal varicose veins remains debated. Concomitant procedures mainly involves thermal ablation with ultrasound-guided foam sclerotherapy or phlebectomy. Staged strategies include initial truncal ablation followed by deliberated tributary management. Major venous disease guidelines exhibit substantial divergence,Japanese Society of Phlebology guidelines in 2019 contraindicate concomitant procedures, European Society for Vascular Surgery 2022 Clinical Practice Guidelines and Chinese frameworks endorse individualized decision-making,while American Vein and Lymphatic Society guidelines in 2023 prioritize concomitant procedures. Systematic literature review reveals that concomitant procedures do not uniformly translate into reduced reintervention rates or improved early Venous Clinical Severity Scores, yet consistently incur elevated complication risks and postoperative pain. Conversely, staged strategies offer superior tolerability with minimized complications. Hemodynamic principles indicate that most competent tributaries undergo partial or complete regression within 6 weeks to 6 months post-ablation and hemodynamic studies demonstrate that staged approaches preserve the drainage function of tributaries, preventing edema in their respective drainage territories and reducing tributary intervention rates. Future multicenter randomized controlled trials are imperative to delineate comparative outcomes between concomitant and staged management of truncal and tributary veins.

Objective:To discuss the clinical characteristics,intervention timing,diagnosis and treatment plan,and prognosis of one patient with immune thrombotic thrombocytopenic purpura(iTTP),and to provide more clinical evidences for the precise diagnosis and treatment of this rare disease.Methods:The clinical data of one patient with iTTP were collected,who had been previously misdiagnosed with acute infection after receiving a virus-inactivated vaccine.The data included clinical manifestations and ancillary examination informations.The relevant literatures were reviewed.Results:The patient,a 60-year-old male,was admitted with"fever for 6 d."The physical examination results showed scattered red maculopapules on the lower limbs,with only mild thrombocytopenia initially,and the admission PLASMIC score was 5 points.Initially diagnosed with acute infection,the patient was treated with anti-inflammatory,anti-infective,and corticosteroid therapies,but the response was poor.After one week,the re-evaluation results showed a significant decrease in the platelet count,progressing to severe thrombocytopenia,hematuria,dark-colored urine,and neurological and psychiatric symptoms as the disease progressed.The further examination results showed the PLASMIC score was increased to 7 points.After high suspicion of iTTP,therapeutic plasma exchange(TPE)was initiated immediately.The a disintegrin and metalloproteinase with thrombospondin type 1 motif member 13(ADATMS13)activity level was<1%during treatment,and the test for ADAMTS13 inhibitors was positive.The genetic testing results revealed a missense mutation in an iTTP-susceptible gene.After a confirmed diagnosis,the patient was treated regularly with intravenous rituximab,completing four treatment cycles,and followed up to the present;the treatment deemed effective.Conclusion:iTTP is often delayed in the diagnosis due to atypical initial clinical symptoms.Once suspected,the treatment based on TPE and glucocorticoids should be initiated immediately.New drugs like rituximab provide a multidisciplinary treatment strategy option for iTTP.

Objective:To explore the applied therapeutic effect of digital surgical technique combined with three dimensional(3D)printing guide plate in surgery of maxillofacial fracture.Methods:A total of forty patients with maxillofacial fracture who admitted to the Department of Stomatology at the First Medical Center of Chinese PLA General Hospital from June 2019 to June 2023 were selected.They were divided into an observation group(18 cases)and a control group(22 cases)based on different surgical methods.The observation group used digital technique combined with 3D printing technique to conduct surgery by auxiliary method,and the control group used routine open reduction and internal fixation surgery for maxillofacial fracture.The surgical time,bleeding volume,complications and satisfaction evaluation between two groups of patients were observed and compared.Results:All patients obtained clinical cure after open reduction and internal fixation surgery,and the surgical time(2.01±0.52)h and bleeding volume(123.89±67.31)mL during surgery of observation group were significantly lower than those of control group(U=62.000,26.500,P<0.05),respectively.The incidence of the complications in the observation group was significantly lower than that in the control group,and the difference was statistically significant(x2=4.675,P<0.05),and there were no statistically significant difference in infection and limited incision opening between the two groups(P>0.05).In the satisfaction evaluation,there was a significant difference in appearance satisfaction scores between the observation group(8.89±0.758)and the control group(7.73±0.827)(U=66.000,P<0.05),while there were no statistically significant differences in chewing and language aspects between two groups(P>0.05).Conclusion:The combination of digital technique and 3D printing guide plate has favorable clinical guidance effect in maxillofacial fracture surgery,which can significantly improve surgical efficacy,and reduce the incidence of complications,and obtain higher patient satisfaction.It is worth to be applied in clinical practice.

Objective To explore the mechanobiological mechanism of fluid shear force(FSF)on the protection,injury,and destruction of the structure and function of the blood-brain barrier(BBB)under normal physiological conditions,ischemic hypoperfusion,and postoperative hyperperfusion conditions.BBB is mainly composed of brain microvascular endothelial cells.Rat brain microvascular endothelial cells(rBMECs)were used as model cells to conduct the investigation.Methods rBMECs were seeded at a density of 1×105 cells/cm2 and incubated for 48 h.FSF was applied to the rBMECs at 0.5,2,and 20 dyn/cm2,respectively,simulating the stress BBB incurs under low perfusion,normal physiological conditions,and high FSF after bypass grafting when there is cerebral vascular stenosis.In addition,a rBMECs static culture group was set up as the control(no force was applied).Light microscope,scanning electron microscope(SEM),and laser confocal microscope(LSCM)were used to observe the changes in cell morphology and cytoskeleton.Transmission electron microscope(TEM)was used to observe the tight junctions.Immunofluorescence assay was performed to determine changes in the distribution of tight junction-associated proteins claudin-5,occludin,and ZO-1 and adherens junction-associated proteins VE-cadherin and PECAM-1.Western blot was performed to determine the expression levels of tight junction-associated proteins claudin-5,ZO-1,and JAM4,adherens junction-associated protein VE-cadherin,and key proteins in Rho GTPases signaling(Rac1,Cdc42,and RhoA)under FSF at different intensities.Results Microscopic observation showed that the cytoskeleton exhibited disorderly arrangement and irregular orientation under static culture and low shear force(0.5 dyn/cm2).Under normal physiological shear force(2 dyn/cm2),the cytoskeleton was rearranged in the orientation of the FSF and an effective tight junction structure was observed between cells.Under high shear force(20 dyn/cm2),the intercellular space was enlarged and no effective tight junction structure was observed.Immunofluorescence results showed that,under low shear force,the gap between the cells decreased,but there was also decreased distribution of tight junction-associated proteins and adherens junction-associated proteins at the intercellular junctions.Under normal physiological conditions,the cells were tightly connected and most of the tight junction-associated proteins were concentrated at the intercellular junctions.Under high shear force,the gap between the cells increased significantly and the tight junction and adherens junction structures were disrupted.According to the Western blot results,under low shear force,the expression levels of claudin-5,ZO-1,and VE-cadherin were significantly up-regulated compared with those of the control group(P<0.05).Under normal physiological shear force,claudin-5,ZO-1,JAM4,and VE-cadherin were highly expressed compared with those of the control group(P<0.05).Under high shear force,the expressions of claudin-5,ZO-1,JAM4,and VE-cadherin were significantly down-regulated compared with those of the normal physiological shear force group(P<0.05).Under normal physiological shear force,intercellular expressions of Rho GTPases proteins(Rac1,Cdc42,and RhoA)were up-regulated and were higher than those of the other experimental groups(P<0.05).The expressions of Rho GTPases under low and high shear forces were down-regulated compared with that of the normal physiological shear force group(P<0.05).Conclusion Under normal physiological conditions,FSF helps maintain the integrity of the BBB structure,while low or high shear force can damage or destroy the BBB structure.The regulation of BBB by FSF is closely related to the expression and distribution of tight junction-associated proteins and adherens junction-associated proteins.

Objective:To understand the gene characteristics of Sapovirus from diarrhea cases in diarrhoeal disease clinics in Beijing.Methods:In 2019, stool samples were collected from diarrhea cases in diarrhoeal disease clinics in Beijing. The samples were used for the detection of nucleic acid of Sapovirus with real-time RT-PCR. Different RT-PCR methods were used for the partial gene segment amplification in the capsid protein VP1 region and the polymerase RdRp region, and sequencing was conducted for amplified positive products. The sequences were aligned with software BioEdit 7.0.9.0 and analyzed with software Mega 6.06.Results:The overall detection rate of Sapovirus was 2.89% (44/1 522), the detection rate in children under 5 years old was 3.34% (18/539) and 2.64% (26/983) in children aged ≥5 years. The capsid protein VP1 region was sequenced in 23 strains belonging to 8 genotypes (GⅠ.2 had 6 strains, GⅠ.1 and GⅡ.3 had 5 strains, respectively, GⅠ.3 and GⅡ.5 had 2 strains, respectively, GⅠ.5, GⅡ.1 and GⅣ.1 had 1 strain, respectively). A total of 16 strains were detected in the cases aged ≥5 years, and the proportion of GⅠ.2 was highest (37.50%, 6/16), and 7 strains were detected in the cases under 5 years old, the proportions of GⅠ.1 and GⅡ.3 were highest (both 42.86%, 3/7); The internal similarity of each genotype was 95.5%-100.0%, and the similarity with the 51 reference strains of human or sewage sources in different years and different countries was 92.2%-100.0%. The polymerase RdRp region was sequenced in 25 strains belonging to 8 genotypes (GⅡ.P3 had 9 strains, GⅠ.P3 had 4 strains, GⅠ.P1, GⅠ.P2 and GⅡ.P1 had 3 strains, respectively, GⅠ.P5, GⅡ.P5 and GⅣ.P1 had 1 strain, respectively). Fifteen strains were detected in the cases aged ≥5 years, and GⅡ.P3 had the highest proportion (40.00%, 6/15). Ten strains were detected in the cases under 5 years old, and the proportions of GⅠ. P1, GⅡ.P1 and GⅡ.P3 were highest (all 30.00%, 3/10); The internal similarity of each genotype was 94.0%-100.0%, and the similarity with the 39 reference strains of human or sewage sources in different years and different countries was 90.2%-99.1%.Conclusions:Sapovirus is one of the pathogens among diarrhea cases in Beijing. The main genome is GⅠ and GⅡ, and the genotypes are diverse and dispersed. The main genotypes of diarrhea cases in people aged ≥5 years and less than 5 years are different.

Contaminations of SARS-CoV-2 have been found for many times in imported cold chain aquatic products and their packaging materials in China. The purpose of this paper is to analyze the contamination status, sources and transmission risks of SARS-CoV-2 in imported cold chain aquatic products, and try to put forward relevant suggestions and strategies in order to provide evidence for the prevention and control of SARS-CoV-2 infection.