BACKGROUND:Liuwei Dihuang Wan takes"three tonifying and three reducing effects"as its compatibility feature to nourish yin and tonify the kidneys,while Zuogui Wan takes"seeking yin in yang"as its compatibility feature to nourish yin and tonify the kidneys by promoting yang.Both of them belong to the same method of nourishing yin and tonifying the kidneys,and have better curative effects at the symptomatic and cellular molecular levels. OBJECTIVE:To observe the effects of Liuwei Dihuang Wan and Zuogui Wan in bone metabolism,and to explore their mechanism of action in the osteoprotegerin(OPG)/receptor activator of nuclear factor-κB ligand(RANKL)osteoblastic pathway. METHODS:Thirty-two Sprague-Dawley rats were randomized into model,Liuwei Dihuang Wan,Zuogui Wan,and sham operation group,with eight rats in each group.Osteoporosis models were prepared using removal of both ovaries in the first three groups.Starting at 30 days postoperatively,rats in the Liuwei Dihuang Wan group were gavaged with Liuwei Dihuang Wan 1.125 g/kg/d;rats in the Zuoqui Wan group were gavaged with Zuogui Wan 2.25 g/kg/d;and rats in the sham operation group and the model group were gavaged with saline 10 mL/kg/d.After 12 weeks of gavage,the rat tibia was taken to measure bone mineral density.The serum levels of estrogen,bone alkaline phosphatase,and cAMP/cGMP were measured using ELISA,and the expression of OPG/RANKL in the femur was detected using western blot. RESULTS AND CONCLUSION:Compared with the sham operation group,the model group showed a decrease in bone mineral density and levels of estrogen and bone alkaline phosphatase(P＜0.05)and an increase in cAMP/cGMP level(P＜0.05).Compared with the model group,the Liuwei Dihuang Wan group and the Zuogui Wan group significantly increased bone mineral density(P＜0.05)and bone alkaline phosphatase levels(P＜0.05);the Zuogui Wan group significantly decreased cAMP/cGMP levels(P＜0.05)and upregulated OPG expression(P＜0.05);the Liuwei Dihuang Wan group upregulated OPG expression and downregulated RANKL expression(P＜0.05);and both groups were unable to significantly increase estrogen levels(P＞0.05).To conclude,Zuogui Wan,which seeks yin from yang,can effectively increase the expression of OPG but cannot downregulate the expression of RANKL.However,Liuwei Dihuang Wan,which has three tonifying and three reducing effects,can bidirectionally regulate the expression of OPG and RANKL.This result suggests that Liuwei Dihuang Wan can significantly inhibit osteoclastic function compared with Zuogui Wan,and further research is needed to verify this conclusion.

Objective:To investigate the relationship between serum apolipoprotein B (ApoB)/ apolipoprotein A1 (ApoA1), total cholesterol (TC)/ high-density lipoprotein cholesterol (HDL-C), and major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) after interventional therapy.Methods:This study was a retrospective analysis of 180 patients with STEMI who completed percutaneous coronary intervention (PCI) in the Xidian Group Hospital between January 2020 and December 2023. Based on the occurrence of MACE during the 6-month follow-up period after PCI, the patients were divided into MACE group of 25 cases and non MACE group of 155 cases. The general data, serum ApoB/ApoA1, TC/HDL-C before PCI and laboratory test data were compared between the two groups. The relationship between serum ApoB/ApoA1, TC/HDL-C and MACE in STEMI patients after interventional therapy was analyzed.Results:The proportion of Killip heart function grade Ⅲ, serum cardiac troponin I, B-type natriuretic peptide, ApoB, TC, ApoB/ApoA1 and TC/HDL-C in the MACE group were higher than those in the non MACE group: 64.00% (16/25) vs. 41.94% (65/155), (134.23 ± 20.21) ng/L vs. (122.18 ± 19.41) ng/L, (75.23 ± 16.18) ng/L vs. (68.22 ± 15.49) ng/L, (1.08 ± 0.23) g/L vs. (0.95 ± 0.25) g/L, (5.20 ± 0.85) mmol/L vs. (4.82 ± 0.81) mmol/L, 0.92 (0.78, 1.06) vs. 0.74 (0.61, 0.87), 4.28 (3.71, 4.91) vs. 3.72 (3.11, 4.31). The levels of ApoA1 and HDL-C were lower in the MACE group compared to the non MACE group: (1.19 ± 0.21) g/L vs. (1.30 ± 0.26) g/L, (1.21 ± 0.13) mmol/L vs. (1.31 ± 0.21) mmol/L, with statistically significant differences ( P<0.05). Logistic regression analysis found that the occurrence of MACE in STEMI patients after interventional treatment was related to serum cardiac troponin I, ApoB, ApoB/ApoA1 and TC/HDL-C ( P<0.05). Restrictive cubic spline analysis showed a non-linear dose-response relationship between serum ApoB/ApoA1, TC/HDL-C and MACE after interventional treatment in STEMI patients ( P<0.05). When serum ApoB/ApoA1 ≥ 0.76 and TC/HDL-C ≥ 3.86, the risk of MACE in patients increased with the increase of both ratios. The serum ApoB/ApoA1 and TC/HDL-C had a positive interactive effect on the occurrence of MACE in STEMI patients after interventional therapy. The decision curve and column chart showed that the predictive model constructed with the assistance of serum ApoB/ApoA1 and TC/HDL-C had ideal predictive value for MACE after interventional treatment in STEMI patients. Conclusions:The occurrence of MACE in STEMI patients after interventional treatment is related to the serum ApoB/ApoA1 and TC/HDL-C. The risk of MACE increases with the increase of these two ratios, and they have a positive interaction with MACE occurrence, which can be used as an auxiliary indicator for early assessment of MACE occurrence.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To explore the value of the "sandwich" feedback method based on the PDCA (plan, do, check, action) cycle in improving the ability of faculty in the department of radiology in teaching clinical radiological image interpretation during standardized residency training.Methods:The study involved six faculty members engaged in standardized residency training in the department of radiology from January 2023 to January 2024. The "sandwich" feedback method based on PDCA cycle was adopted to improve their ability in teaching clinical radiological image interpretation quarterly. The teaching ability was evaluated by residents and peer faculty members. A survey on teaching satisfaction was carried out.Results:Comparison of the teaching ability between PDCA cycles demonstrated a progressive increase in scores as rated by both residents and peer faculty members (scores from quarter 1 to quarter 4 were (77.00±2.53)/(80.33±3.26), (79.16±2.04)/(82.83±2.86), (81.83±1.17)/(85.16±1.17), (83.00±1.41)/(86.00±1.41). ANOVA of repeated measures indicated that quarter had a significant impact on both peer faculty member and resident evaluations ( P<0.001), and the results remained significant after Greenhouse-Geisser correction (G-G) and Huynh-Feldt correction (H-F). Moreover, a steady increase was observed in the scores of common deficiencies. The questionnaire survey showed that 88.88% (24/27) of the faculty members were "satisfied" or "very satisfied" with the feedback model. There were no significant differences in the scores of teaching feedback is necessary and aids in standardized teaching activities, creating an atmosphere before feedback is essential and effective "sandwich" feedback is helpful in improving the ability of faculty in teaching radiological image interpretation, and "sandwich" feedback can promote teaching reflection among faculty" between resident and peer faculty member evaluations ( P>0.05). Conclusions:The "sandwich" feedback method based on the PDCA cycle can effectively improve the ability of faculty in teaching clinical radiological image interpretation in the department of radiology and provide new ideas for achieving teaching homogeneity.

Objective:To explore different types of psychological reactions of spouses of young and middle-aged breast cancer patients and their influencing factors based on potential profile analysis, so as to provide reference for targeted intervention in clinical practice.Methods:A cross-sectional investigation method was used to select the spouses of middle-aged and young patients with breast cancer who were hospitalized in the Second Affiliated Hospital of Guilin Medical University, Quanzhou County People's Hospital, and Bobai County People's Hospital from January 2023 to June 2024. General Data Questionnaire, Spousal Psychological Response Scale of Breast Cancer Patients, Perceived Partner Responsiveness Scale and Perceptive Social Support Scale were used to investigate. The potential profile analysis of spousal psychological reaction of young and middle-aged breast cancer patients was carried out, and the influencing factors of different categories were analyzed by ordered multiple Logistic regression.Results:A total of 232 questionnaires were distributed, and 211 valid questionnaires were collected, with an effective response rate of 91.0%.The spouses of 211 middle-aged and young patients with breast cancer were 30-59 (43.25 ± 2.58) years old. The total psychological response score was (69.96 ± 8.36). The low psychological response high coping group accounted for 24.6% (52/211), the moderate psychological response group accounted for 33.2% (70/211), and the high psychological response low coping group accounted for 42.2% (89/211). The results of ordered multiple Logistic regression analysis showed that cumulative care time, tumor stage of patients, perceived partner responsiveness, and perceived social support were the influencing factors of potential categories of psychological responses of spouses of young and middle-aged breast cancer patients ( OR values were 0.014-0.304, all P<0.05). Conclusions:There is heterogeneity in the psychological reactions of spouses of young and middle-aged breast cancer patients. According to the characteristics of the classification, the nursing staff should formulate targeted intervention strategies, focusing on improving the perceived partner responsiveness, establishing an effective social support system, and reducing the level of psychological response.

Objective:To explore the value of the "sandwich" feedback method based on the PDCA (plan, do, check, action) cycle in improving the ability of faculty in the department of radiology in teaching clinical radiological image interpretation during standardized residency training.Methods:The study involved six faculty members engaged in standardized residency training in the department of radiology from January 2023 to January 2024. The "sandwich" feedback method based on PDCA cycle was adopted to improve their ability in teaching clinical radiological image interpretation quarterly. The teaching ability was evaluated by residents and peer faculty members. A survey on teaching satisfaction was carried out.Results:Comparison of the teaching ability between PDCA cycles demonstrated a progressive increase in scores as rated by both residents and peer faculty members (scores from quarter 1 to quarter 4 were (77.00±2.53)/(80.33±3.26), (79.16±2.04)/(82.83±2.86), (81.83±1.17)/(85.16±1.17), (83.00±1.41)/(86.00±1.41). ANOVA of repeated measures indicated that quarter had a significant impact on both peer faculty member and resident evaluations ( P<0.001), and the results remained significant after Greenhouse-Geisser correction (G-G) and Huynh-Feldt correction (H-F). Moreover, a steady increase was observed in the scores of common deficiencies. The questionnaire survey showed that 88.88% (24/27) of the faculty members were "satisfied" or "very satisfied" with the feedback model. There were no significant differences in the scores of teaching feedback is necessary and aids in standardized teaching activities, creating an atmosphere before feedback is essential and effective "sandwich" feedback is helpful in improving the ability of faculty in teaching radiological image interpretation, and "sandwich" feedback can promote teaching reflection among faculty" between resident and peer faculty member evaluations ( P>0.05). Conclusions:The "sandwich" feedback method based on the PDCA cycle can effectively improve the ability of faculty in teaching clinical radiological image interpretation in the department of radiology and provide new ideas for achieving teaching homogeneity.

Objective:To explore different types of psychological reactions of spouses of young and middle-aged breast cancer patients and their influencing factors based on potential profile analysis, so as to provide reference for targeted intervention in clinical practice.Methods:A cross-sectional investigation method was used to select the spouses of middle-aged and young patients with breast cancer who were hospitalized in the Second Affiliated Hospital of Guilin Medical University, Quanzhou County People's Hospital, and Bobai County People's Hospital from January 2023 to June 2024. General Data Questionnaire, Spousal Psychological Response Scale of Breast Cancer Patients, Perceived Partner Responsiveness Scale and Perceptive Social Support Scale were used to investigate. The potential profile analysis of spousal psychological reaction of young and middle-aged breast cancer patients was carried out, and the influencing factors of different categories were analyzed by ordered multiple Logistic regression.Results:A total of 232 questionnaires were distributed, and 211 valid questionnaires were collected, with an effective response rate of 91.0%.The spouses of 211 middle-aged and young patients with breast cancer were 30-59 (43.25 ± 2.58) years old. The total psychological response score was (69.96 ± 8.36). The low psychological response high coping group accounted for 24.6% (52/211), the moderate psychological response group accounted for 33.2% (70/211), and the high psychological response low coping group accounted for 42.2% (89/211). The results of ordered multiple Logistic regression analysis showed that cumulative care time, tumor stage of patients, perceived partner responsiveness, and perceived social support were the influencing factors of potential categories of psychological responses of spouses of young and middle-aged breast cancer patients ( OR values were 0.014-0.304, all P<0.05). Conclusions:There is heterogeneity in the psychological reactions of spouses of young and middle-aged breast cancer patients. According to the characteristics of the classification, the nursing staff should formulate targeted intervention strategies, focusing on improving the perceived partner responsiveness, establishing an effective social support system, and reducing the level of psychological response.

Objective:To investigate the relationship between serum apolipoprotein B (ApoB)/ apolipoprotein A1 (ApoA1), total cholesterol (TC)/ high-density lipoprotein cholesterol (HDL-C), and major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) after interventional therapy.Methods:This study was a retrospective analysis of 180 patients with STEMI who completed percutaneous coronary intervention (PCI) in the Xidian Group Hospital between January 2020 and December 2023. Based on the occurrence of MACE during the 6-month follow-up period after PCI, the patients were divided into MACE group of 25 cases and non MACE group of 155 cases. The general data, serum ApoB/ApoA1, TC/HDL-C before PCI and laboratory test data were compared between the two groups. The relationship between serum ApoB/ApoA1, TC/HDL-C and MACE in STEMI patients after interventional therapy was analyzed.Results:The proportion of Killip heart function grade Ⅲ, serum cardiac troponin I, B-type natriuretic peptide, ApoB, TC, ApoB/ApoA1 and TC/HDL-C in the MACE group were higher than those in the non MACE group: 64.00% (16/25) vs. 41.94% (65/155), (134.23 ± 20.21) ng/L vs. (122.18 ± 19.41) ng/L, (75.23 ± 16.18) ng/L vs. (68.22 ± 15.49) ng/L, (1.08 ± 0.23) g/L vs. (0.95 ± 0.25) g/L, (5.20 ± 0.85) mmol/L vs. (4.82 ± 0.81) mmol/L, 0.92 (0.78, 1.06) vs. 0.74 (0.61, 0.87), 4.28 (3.71, 4.91) vs. 3.72 (3.11, 4.31). The levels of ApoA1 and HDL-C were lower in the MACE group compared to the non MACE group: (1.19 ± 0.21) g/L vs. (1.30 ± 0.26) g/L, (1.21 ± 0.13) mmol/L vs. (1.31 ± 0.21) mmol/L, with statistically significant differences ( P<0.05). Logistic regression analysis found that the occurrence of MACE in STEMI patients after interventional treatment was related to serum cardiac troponin I, ApoB, ApoB/ApoA1 and TC/HDL-C ( P<0.05). Restrictive cubic spline analysis showed a non-linear dose-response relationship between serum ApoB/ApoA1, TC/HDL-C and MACE after interventional treatment in STEMI patients ( P<0.05). When serum ApoB/ApoA1 ≥ 0.76 and TC/HDL-C ≥ 3.86, the risk of MACE in patients increased with the increase of both ratios. The serum ApoB/ApoA1 and TC/HDL-C had a positive interactive effect on the occurrence of MACE in STEMI patients after interventional therapy. The decision curve and column chart showed that the predictive model constructed with the assistance of serum ApoB/ApoA1 and TC/HDL-C had ideal predictive value for MACE after interventional treatment in STEMI patients. Conclusions:The occurrence of MACE in STEMI patients after interventional treatment is related to the serum ApoB/ApoA1 and TC/HDL-C. The risk of MACE increases with the increase of these two ratios, and they have a positive interaction with MACE occurrence, which can be used as an auxiliary indicator for early assessment of MACE occurrence.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To explore the protective effect and mechanism of Tongfu Lifei decoction (TFL) on human monocytic leukemia cell THP-1 induced by lipopolysaccharide (LPS).Methods:① THP-1 cells were cultured in vitro, and incubated with 1 mg/L LPS for 18 hours to construct an in vitro THP-1 cell inflammation model. Other THP-1 cells were taken as blank control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) secreted by cells. ② THP-1 cells were divided into seven groups and treated with 0, 0.005, 0.01, 0.02, 0.04, 0.08, and 0.16 mL/mL TFL for 24 hours (added different dosages of TFL solution per milliliter of culture medium, with a crude drug content of 1 kg/L). The cell survival rate was detected using methyl thiazolyl tetrazolium (MTT) colorimetric method, and the intervention dosage of TFL for its non-toxic effect on THP-1 cells was screened. ③ Another THP-1 cells were divide into inflammatory model group and 0.01, 0.02, and 0.04 mL/mL TFL groups according to the intervention dosage of TFL screened by MTT colorimetry. After 24 hours of intervention, the levels of TNF-α and IL-6 secreted by cells were measured using ELISA. Western blotting was used to detect the expressions of programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) signaling pathway proteins in cells. Real time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expressions of microRNAs (miR-146a, miR-146b, miR-155) in cells. ④ The maximum non-toxic concentration of TFL (0.04 mL/mL) on the THP-1 cell was selected as the intervention dose. THP-1 cells were divided into inflammation model group, TFL group, TFL+miR-146a inhibitor group, TFL+miR-146b inhibitor group, and TFL+miR-155 inhibitor group. The inflammation model group was not given any drug intervention. The other inhibitor groups were added 100 nmol/L corresponding inhibitor. After 24 hours of intervention, the levels of TNF-α and IL-6 secreted by cells were measured using ELISA. Western blotting was used to detect the expressions of PD-1/PD-L1 signaling pathway proteins in cells. Results:① Compared with the blank control group, the levels of TNF-α and IL-6 secreted by cells in the inflammatory model group were significantly increased, indicating the successful construction of the THP-1 inflammatory cell model in vitro. ② 0-0.04 mL/mL TFL had no toxic effect on THP-1 cells. However, the survival rates of cells in the 0.08 mL/mL and 0.16 mL/mL TFL groups were significantly lower than those in the inflammation model group, indicating that TFL dosages exceeding 0.04 mL/mL had toxic effects on THP-1 cells. ③ Compared with the inflammation model group, 0.01 mL/mL TFL had no significant effect on the levels of TNF-α and IL-6 secreted by THP-1 cells, while intervention with 0.02 mL/mL and 0.04 mL/mL TFL significantly reduced the levels of TNF-α and IL-6 secreted by cells [TNF-α(ng/L): 95.89±8.55, 70.73±11.70 vs. 137.10±7.19, IL-6 (ng/L): 23.03±2.55, 16.58±1.72 vs. 32.60±2.55, all P < 0.01]. Compared with the inflammation model group, the expressions of PD-1/PD-L1 signaling pathway proteins in THP-1 cells in different dosages of TFL groups were significantly reduced, and showed a certain dosage dependence. The expressions of the pathway proteins in the 0.04 mL/mL TFL group were significantly lower than those in the inflammation model group [PD-1 protein (PD-1/β-actin): 0.28±0.04 vs. 1.00±0.10, PD-L1 protein (PD-L1/β-actin): 0.54±0.05 vs. 1.00±0.08, phosphoinositide 3-kinase (PI3K) protein (PI3K/β-actin): 0.28±0.03 vs. 1.00±0.08, phosphorylated protein kinase B (p-Akt) protein (p-Akt/Akt): 0.38±0.04 vs. 1.00±0.10, all P < 0.01]. Compared with the inflammation model group, the expression of miR-146a in THP-1 cells in the 0.01, 0.02, and 0.04 mL/mL TFL groups was significantly reduced (2 -ΔΔCt: 0.46±0.11, 0.31±0.13, 0.23±0.14 vs. 1.01±0.18, all P < 0.01), while there was no significant change in the expressions of miR-146b and miR-155. ④ Compared with the inflammation model group, the TFL group showed a significant decrease in the levels of TNF-α and IL-6 secreted by THP-1 cells. The miR-146a inhibitor could significantly reverse the inhibitory effect of TFL on inflammatory factors, and the difference was statistically significant as compared with the TFL group [TNF-α (ng/L): 138.55±10.30 vs. 72.33±10.59, IL-6 (ng/L): 31.35±3.98 vs. 15.75±3.76, both P < 0.01]. Compared with the inflammation model group, the expressions of PD-1/PD-L1 signaling pathway proteins in THP-1 cells in the TFL group were significantly reduced. The expressions of pathway proteins in cells in the TFL+miR-146a inhibitor group were significantly higher than those in the TFL group [PD-1 protein (PD-1/β-actin): 0.85±0.09 vs. 0.37±0.04, PD-L1 protein (PD-L1/β-actin): 0.83±0.08 vs. 0.55±0.06, PI3K protein (PI3K/β-actin): 0.85±0.09 vs. 0.63±0.06, p-Akt protein (p-Akt/Akt): 0.98±0.10 vs. 0.75±0.07, all P < 0.05]. Conclusion:TFL regulates the expression of miR-146a to inhibit the PD-1/PD-L1 signaling pathway in THP-1 cells, regulates the immune barrier of sepsis induced in cell inflammation model in vitro, and thus protects LPS induced THP-1 cells.