Objective To explore the clinical efficacy of erigeron breviscapus injection combined with atorvastatin calcium in patients with acute ischemic stroke(AIS)and its impact on systemic inflammatory markers.Methods A total of 151 AIS patients diagnosed and treated from January 2020 to December 2022 were selected and divided into the control group(n=75)and the study group(n=76)by random number method.The control group was given oral atorvastatin calcium treatment,and the study group was additionally treated with erigeron breviscapus injection on this basis.Before treatment,7 d and 14 d after treatment,neurological function[National Institutes of Health Stroke Scale(NIHSS)],motor function[Fugl-Meyer Assessment(FMA)],activities of daily living[Barthel Index(ADL)]and systemic inflammatory markers such as tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin(IL)-6,lymphocytes(LYM),white blood cells(WBC),neutrophils(NEU)and platelets(PLT)were evaluated.Efficacy evaluation was conducted after 14 days of treatment.The adverse reactions of patients during the treatment period were recorded for safety assessment.Results The NIHSS score,TNF-α,CRP,IL-6,WBC,NEU and PLT levels were lower in the study group than those in the control group after 7 d and 14 d treatment,and decreased with the increase of treatment time(P＜0.05).After 7 d and 14 d treatment,FMA score,ADL score and LYM level were higher in the study group than those in the control group,and increased with the prolongation of treatment time(P＜0.05).TNF-α,CRP,IL-6,WBC,NEU and PLT were positively correlated with NIHSS score,and negatively correlated with FMA score and ADL score.LYM was negatively correlated with NIHSS score,and positively correlated with FMA score and ADL score(P＜0.05).The total effective rate was higher in the study group than that of the control group(P＜0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P＞0.05).Conclusion After the combined treatment of AIS with erigeron breviscapus injection and atorvastatin calcium,the systemic inflammatory level of patients decreases significantly,the curative effect is good and the safety is high.

Objective:The high-quality clinical studies published in the field of hypertriglyceridemia associated acute pancreatitis (HTG-AP) were summarized to analyze the incidence and trends of HTG-AP in China.Methods:Clinical studies related to acute pancreatitis in PubMed, Medline, Cochrane Library and Web of Science from January 1, 2000 to November 12, 2021 were searched and screened. Keywords included China, acute pancreatitis, and clinical study. According to the inclusion and exclusion criteria, related literature were accurately selected and evaluated before extracting data. Meta-analysis was performed using R4.2 and RevMan5.3 software. The effect sizes of annual average percentage change (AAPC) for acute pancreatitis in different regions were merged and forest plot was drawn. Patients were divided into severe acute pancreatitis (SAP) group, moderately severe acute pancreatitis (MSAP) group and mild acute pancreatitis (MAP) group, and forest plot was drawn to analyze the AAPC of HTG-AP. Regression curve for time-dependent changes in the percentage of AP with different etiological factors was constructed.Results:Totally, 67 articles (33 randomized clinical trials, 34 retrospective cohort study) and 30 421 patients were included. The meta-analysis showed that the proportion of HTG-AP among AP patients was increasing over the past 20 years, with an AAPC of 0.52% (95% CI 0.34-1.39). In subgroup analyses, the proportion of HTG-AP in SAP and MSAP group both increased significantly, with the AAPC of 0.74% (95% CI 0.23-1.24) and 3.12% (95% CI 1.62-4.63), respectively. Furthermore, the proportion of HTG-AP among AP patients has shown an upward trend over the past 20 years with faster speed. The proportion of biliary pancreatitis among AP patients has also shown an upward trend, with the rate of increase gradually slowed. The proportion of alcohol-associated pancreatitis among AP patients has remained stable. Conclusions:Since 2000, the incidence proportion of HTG-AP has significantly increased in China with the rate of increase gradually quicker.

Objective:To investigate the impact of plasmapheresis therapy on the clinical efficacy in predicted severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) patients.Methods:The clinical data of 500 HTG-AP patients admitted to 36 medical centers across China in the Chinese Acute Pancreatitis Clinical Trials Group-PERFORM database from November 2020 to June 2023 were retrospectively analyzed. Besides the inclusion and exclusion criteria from PERFORM study, patients who had acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score ≥8 or CRP>150 mg/L on admission were included in the final analyses ( n=189). Patients were categorized into the plasmapheresis group ( n=51) and the routine treatment group ( n=138) according to the triglyceride-lowering therapies they received. General data, laboratory findings, AP severity, and clinical outcomes were recorded. Results:Patients undergoing plasmapheresis had higher initial triglyceride levels, APACHEⅡ score, SOFA score, and more organ failure than those receiving routine medical treatment. Results of multivariable logistic regression models showed that the plasmapheresis group, as compared to the routine treatment group, was neither associated with decreased risk of persistent organ failure within 14 days [54.9% (28/51) vs 37.7% (52/138), OR=0.89, 95% CI 0.36-2.21, P=0.810], nor with reduced incidence of organ failure on day 7 [17.7% (9/51) vs 15.9% (22/138), OR=0.60, 95% CI 0.19-1.88, P=0.378]. There was no significant difference on the dynamic changes of serum triglyceride within the first three days of admission ( P=0.108). Conclusions:Early plasmapheresis is not associated with reduced incidence of persistent organ failure in predicted severe HTG-AP patients.

Objective To explore the clinical efficacy of erigeron breviscapus injection combined with atorvastatin calcium in patients with acute ischemic stroke(AIS)and its impact on systemic inflammatory markers.Methods A total of 151 AIS patients diagnosed and treated from January 2020 to December 2022 were selected and divided into the control group(n=75)and the study group(n=76)by random number method.The control group was given oral atorvastatin calcium treatment,and the study group was additionally treated with erigeron breviscapus injection on this basis.Before treatment,7 d and 14 d after treatment,neurological function[National Institutes of Health Stroke Scale(NIHSS)],motor function[Fugl-Meyer Assessment(FMA)],activities of daily living[Barthel Index(ADL)]and systemic inflammatory markers such as tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin(IL)-6,lymphocytes(LYM),white blood cells(WBC),neutrophils(NEU)and platelets(PLT)were evaluated.Efficacy evaluation was conducted after 14 days of treatment.The adverse reactions of patients during the treatment period were recorded for safety assessment.Results The NIHSS score,TNF-α,CRP,IL-6,WBC,NEU and PLT levels were lower in the study group than those in the control group after 7 d and 14 d treatment,and decreased with the increase of treatment time(P＜0.05).After 7 d and 14 d treatment,FMA score,ADL score and LYM level were higher in the study group than those in the control group,and increased with the prolongation of treatment time(P＜0.05).TNF-α,CRP,IL-6,WBC,NEU and PLT were positively correlated with NIHSS score,and negatively correlated with FMA score and ADL score.LYM was negatively correlated with NIHSS score,and positively correlated with FMA score and ADL score(P＜0.05).The total effective rate was higher in the study group than that of the control group(P＜0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P＞0.05).Conclusion After the combined treatment of AIS with erigeron breviscapus injection and atorvastatin calcium,the systemic inflammatory level of patients decreases significantly,the curative effect is good and the safety is high.

Objective:The high-quality clinical studies published in the field of hypertriglyceridemia associated acute pancreatitis (HTG-AP) were summarized to analyze the incidence and trends of HTG-AP in China.Methods:Clinical studies related to acute pancreatitis in PubMed, Medline, Cochrane Library and Web of Science from January 1, 2000 to November 12, 2021 were searched and screened. Keywords included China, acute pancreatitis, and clinical study. According to the inclusion and exclusion criteria, related literature were accurately selected and evaluated before extracting data. Meta-analysis was performed using R4.2 and RevMan5.3 software. The effect sizes of annual average percentage change (AAPC) for acute pancreatitis in different regions were merged and forest plot was drawn. Patients were divided into severe acute pancreatitis (SAP) group, moderately severe acute pancreatitis (MSAP) group and mild acute pancreatitis (MAP) group, and forest plot was drawn to analyze the AAPC of HTG-AP. Regression curve for time-dependent changes in the percentage of AP with different etiological factors was constructed.Results:Totally, 67 articles (33 randomized clinical trials, 34 retrospective cohort study) and 30 421 patients were included. The meta-analysis showed that the proportion of HTG-AP among AP patients was increasing over the past 20 years, with an AAPC of 0.52% (95% CI 0.34-1.39). In subgroup analyses, the proportion of HTG-AP in SAP and MSAP group both increased significantly, with the AAPC of 0.74% (95% CI 0.23-1.24) and 3.12% (95% CI 1.62-4.63), respectively. Furthermore, the proportion of HTG-AP among AP patients has shown an upward trend over the past 20 years with faster speed. The proportion of biliary pancreatitis among AP patients has also shown an upward trend, with the rate of increase gradually slowed. The proportion of alcohol-associated pancreatitis among AP patients has remained stable. Conclusions:Since 2000, the incidence proportion of HTG-AP has significantly increased in China with the rate of increase gradually quicker.

Objective:To investigate the impact of plasmapheresis therapy on the clinical efficacy in predicted severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) patients.Methods:The clinical data of 500 HTG-AP patients admitted to 36 medical centers across China in the Chinese Acute Pancreatitis Clinical Trials Group-PERFORM database from November 2020 to June 2023 were retrospectively analyzed. Besides the inclusion and exclusion criteria from PERFORM study, patients who had acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score ≥8 or CRP>150 mg/L on admission were included in the final analyses ( n=189). Patients were categorized into the plasmapheresis group ( n=51) and the routine treatment group ( n=138) according to the triglyceride-lowering therapies they received. General data, laboratory findings, AP severity, and clinical outcomes were recorded. Results:Patients undergoing plasmapheresis had higher initial triglyceride levels, APACHEⅡ score, SOFA score, and more organ failure than those receiving routine medical treatment. Results of multivariable logistic regression models showed that the plasmapheresis group, as compared to the routine treatment group, was neither associated with decreased risk of persistent organ failure within 14 days [54.9% (28/51) vs 37.7% (52/138), OR=0.89, 95% CI 0.36-2.21, P=0.810], nor with reduced incidence of organ failure on day 7 [17.7% (9/51) vs 15.9% (22/138), OR=0.60, 95% CI 0.19-1.88, P=0.378]. There was no significant difference on the dynamic changes of serum triglyceride within the first three days of admission ( P=0.108). Conclusions:Early plasmapheresis is not associated with reduced incidence of persistent organ failure in predicted severe HTG-AP patients.

Objective:To investigate the clinical characteristics of first-episode and recurrent acute hypertriglyceridemic pancreatitis (HTGP).Methods:The retrospective cohort study was con-ducted. The clinical data of 313 patients with HTGP admitted to 26 medical centers in China in the Chinese Acute Pancreatitis Clinical Research Group (CAPCTG)-PERFORM database from November 2020 to December 2021 were collected. There were 219 males and 94 females, aged 38(32,44)years. Of the 313 patients, 193 patients with first-episode HTGP were allocated into the first-episode group and 120 patients with recurrent HTGP were allocated into the recurrent group. Observation indica-tors: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) comparison of severity and prognosis in the course of disease within 14 days between the two groups; (3) the association between recurrent HTGP and the risk of persistent organ failure (POF); (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Wilcoxon rank sum test. The Kaplan-Meier method was used to plot the cumulative recurrence rate curve and Log-Rank test was used for survival analysis. The Logistic regression model was used for multivariate analysis, and continuous variables were converted into categorical variables according to the mean value or common criteria. Propensity score matching was performed by 1∶1 nearest neighbor matching method, with caliper value of 0.02. Paired t test or Wilcoxon rank sum test and McNemar′s test were used for comparison between matched groups. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 313 patients,208 cases were successfully matched, including 104 cases in the first-episode group and 104 cases in the recurrent group. After propensity score matching, there was no significant difference in demographic characteristics, severity of illness scores and laboratory test between the two groups ( P>0.05). The elimination of gender, acute physiology and chornic health evaluation (APACHE) Ⅱ score, computed tomography severity index score, systemic inflammatory response syndrome score, sequential organ failure assessment score, apolipoprotein E, C-reactive protein, creatinine, lactic acid dehydrogenase, procal-citonin confounding bias ensured comparability between the two groups. (2) Comparison of severity and prognosis in the course of disease within 14 days between the two groups. There were signifi-cant differences in POF and local complications between the first-episode group and the recurrent group ( P<0.05). (3) The association between recurrent HTGP and the risk of POF. Results of uncor-rected univariate analysis showed that there was no association between recurrent HTGP and the risk of POF ( odds ratio=0.78, 95% confidence interval as 0.46-1.30, P>0.05). Results of multivariate analysis after adjusting for covariates such as gender, age, APACHE Ⅱ score, C-reactive protein, triglyceride and total cholesterol showed that compared with first-episode HTGP, recurrent HTGP was associated with a higher risk of POF ( odds ratio=2.22, 95% confidence interval as 1.05-4.71, P<0.05). Results of subgroup analysis showed that age<40 years was associated with an increased risk of POF ( odds ratio=3.31, 95% confidence interval as 1.09-10.08, P<0.05). (4) Follow-up. Twelve of the 313 patients died during hospitalization, including 9 cases in the first-episode group and 3 cases in the recurrent group. The rest of 301 surviving patients, including 184 cases in the first-episode group and 117 cases in the recurrent group, were followed up for 19.2(15.5, 21.9)months. Results of follow-up showed that for 184 survived patients of the first-episode group, 164 cases were followed up and 24 cases experienced recurrence, for 117 survived patients of the recurrent group,29 cases experienced recurrence, showing a significant difference between the two groups ( χ2=4.67, P<0.05). Conclusion:Compared with first-episode HTGP, patients with recurrent HTGP are more prone to POF and local complications, and are more prone to recurrence after discharge. The risk of POF in recurrent HTGP patients is 2.22 times that of those with first-episode, and the risk is higher in patients with age <40 years.

Benign prostatic hyperplasia(BPH)is one of the major chronic complications of type 2 diabetes mellitus(T2DM),and sex steroid hormones are common risk factors for the occurrence of T2DM and BPH.The profiles of sex steroid hormones are simultaneously quantified by LC-MS/MS in the clinical serum of patients,including simple BPH patients,newly diagnosed T2DM patients,T2DM complicated with BPH patients and matched healthy individuals.The G protein-coupled estrogen receptor(GPER)inhibitor G15,GPER knockdown lentivirus,the YAP1 inhibitor verteporfin,YAP1 knockdown/overexpression lentivirus,targeted metabolomics analysis,and Co-IP assays are used to investigate the molecular mechanisms of the disrupted sex steroid hormones homeostasis in the pathological process of T2DM complicated with BPH.The homeostasis of sex steroid hormone is disrupted in the serum of patients,accompanying with the proliferated prostatic epithelial cells(PECs).The sex steroid hormone metabolic profiles of T2DM patients complicated with BPH have the greatest degrees of separation from those of healthy individuals.Elevated 17β-estradiol(E2)is the key contributor to the disrupted sex steroid hormone homeostasis,and is significantly positively related to the clinical characteristics of T2DM patients complicated with BPH.Activating GPER by E2 via Hippo-YAP1 signaling exacerbates high glucose(HG)-induced PECs prolifer-ation through the formation of the YAP1-TEAD4 heterodimer.Knockdown or inhibition of GPER-mediated Hippo-YAP1 signaling suppresses PECs proliferation in HG and E2 co-treated BPH-1 cells.The anti-proliferative effects of verteporfin,an inhibitor of YAP1,are blocked by YAP1 overexpression in HG and E2 co-treated BPH-1 cells.Inactivating E2/GPER/Hippo/YAP1 signaling may be effective at delaying the progression of T2DM complicated with BPH by inhibiting PECs proliferation.

To apply electrical impedance tomography (EIT) technology to assess the lung regional ventilation distribution in patients admitted to the intensive care unit (ICU) after a cardiac surgery, and to analyze its value of predicting patients' short-term prognosis.

Objective:To explore the causal relationship between vascular endothelial growth factor A (VEGF-A) and inflammatory bowel disease (IBD) using two-sample unidirectional Mendelian randomization (MR) analysis.Methods:Datasets based on genome-wide association studies (GWAS) of 91 inflammation-related proteins and GWAS datasets related to IBD were collected from the UK Biobank and the IEU OpenGWAS Project. With VEGF-A as the exposure factor, single nucleotide polymorphisms (SNP) associated with IBD were screened as genetic instrumental variables. The inverse variance weighted (IVW) approach served as the primary method in the two-sample unidirectional MR analysis was used to examine the potential causal link between VEGF-A and IBD. Cochran's Q test was utilized to detect potential heterogeneity, while the MR-PRESSO method and MR-Egger intercept test were employed to assess horizontal pleiotropy. A leave-one-out analysis was conducted to evaluate the sensitivity of the results. Results:GWAS data were sourced from the UK Biobank and the IEU OpenGWAS Project databases, including a total of 4 355 UC patients and 2 128 CD patients. The IVW results suggested that VEGF-A may play a protective role in the onset of UC after Bonferroni correction ( OR = 0.9993, 95% CI: 0.9985~0.99997, P = 0.0421; OR = 0.9991, 95% CI: 0.9984~0.9998, P = 0.0095), while no evidence of causal relationship with CD was found ( P = 0.5024, P = 0.3150). Subsequent meta-analysis of the MR results indicated that VEGF-A was a protective factor for UC ( OR = 0.9992, 95% CI: 0.9987~0.9997, P = 0.0011), while no causal association with CD was found ( OR = 1.0000, 95% CI: 0.9997~1.0004, P = 0.8352). The results of Cochran's Q test indicated no heterogeneity, the MR-Egger intercept suggested no horizontal pleiotropy, the MR-PRESSO outlier test detected no outliers, and the leave-one-out sensitivity analysis revealed no abnormal SNP, indicating that the causal inference from the Mendelian randomization analysis had a certain level of reliability. Conclusion:Mendelian randomization analysis indicates causal relationship between VEGF-A and reduced risk of UC, but no causal relationship is found between VEGF-A and CD.