This paper summarizes Professor SHI Zaixiang's clinical experience in treating high fever caused by sepsis using Chaihu Guizhi Ganjiang Decoction （柴胡桂枝干姜汤）. He holds that the key pathogenesis of sepsis involves constrained heat in the shaoyang and internal accumulation of water and fluids. The clinical manifestations such as high fever， chills， and alternating sensations of cold and heat are attributed to pathogenic heat constrained in the shaoyang. Meanwhile， soft tissue edema and serous cavity effusions are due to shaoyang dysfunction and internal water retention. In clinical practice， treating sepsis-related high fever requires addressing both the shaoyang-constrained heat and the associated edema and effusions. The therapeutic approach focuses on harmonizing the shaoyang and resolving internal fluids， using Chaihu Guizhi Ganjiang Decoction as the base formula with flexible modifications. Professor SHI emphasizes that this formula shows a rapid antipyretic effect， particularly in cases where multiple anti-infective treatments have failed.

ObjectiveTo investigate the effects and potential mechanisms of morning and evening fasting on postprandial lipid responses, a post hoc analysis based on a crossover randomized controlled trial was conducted to assess the effects of different fasting strategies on postprandial lipid metabolism in community residents in Shanghai. MethodsA total of 23 participants took part in a randomized crossover trial involving two intervention days: morning fasting and evening fasting, with a washout period of 6 days between intervention days. Two-way analysis of variance was used to test the differences in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and the relative expression of circadian clock genes before and after the next meal under fasting. Wilcoxon rank sum tests were used to analyze the different metabolites between the two groups. Principal component analysis and Orthogonal partial least squares-discriminant analysis were conducted to evaluate the ability of metabolites to differentiate between morning fasting and evening fasting and identify the important differential metabolites. After adjusting for age, sex, and BMI, a partial correlation analysis was performed to identify metabolites associated with plasma lipids. In addition, important metabolites associated with plasma lipids were computed by pathway enrichment analysis. ResultsAfter evening fasting intervention, fasting TG level [(0.37±0.29) vs (0.27±0.18)] mmol·L^-1, fasting and postprandial change values in TC [(2.74±0.47) vs (2.51±0.27)] mmol·L^-1 and LDL-C [(1.32±0.38) vs (0.99±0.27)] mmol·L^-1 were significantly lower than those after morning fasting (P<0.05). While, change values of fasting LDL-C [(0.89±0.37) vs (1.14±0.37)] mmol·L^-1 and TG [(1.14±0.19) vs (1.28±0.17)] mmol·L^-1 were significantly higher than those after morning fasting intervention (P<0.05). After fasting intervention, the relative expression of AMPK, CRY1, CLOCK, MTNR1B, AANAT, and ASMT was correlated with the amount of plasma lipid changes (P<0.05). Specifically, CLOCK and AANAT were upregulated following evening fasting and downregulated after morning fasting. Among the 217 important differential metabolites, 111 were correlated with plasma lipids, and which were primarily enriched in the cysteine and methionine metabolism pathways (P<0.05). ConclusionCompared to morning fasting, evening fasting was more effective in improving postprandial lipid responses, indicating that an evening fasting window during intermittent fasting could be conducive to cardiovascular disease prevention in adults. Meanwhile, it is suggested that morning and evening fasting may affect lipid responses through circadian rhythm oscillations and the cysteine and methionine metabolism pathways.

Objective:To investigate whether there is a causal relationship between atopic dermatitis(AD)and ankylosing spondylitis(AS).Methods:Genetic data of AD and AS were extracted from genome-wide association studies(GWAS)by Mendelian randomization(MR),and inverse variance-weighted(IVW)analysis was used as main analysis,supplemented by weighted median,MR-Egger,weighted mode,etc,and verified by a series of sensitivity analyses.Results:IVW analysis of AD by AS:OR=1.015,95％CI:1.005～1.025,P=0.004.IVW analysis of AD for AS:OR=1.001,95％CI:1.000～1.002,P=0.120.Conclusion:AS has a statisti-cally small causal relationship on AD,and AD has no causal effect on AS.

Objective:To investigate whether there is a causal relationship between atopic dermatitis(AD)and ankylosing spondylitis(AS).Methods:Genetic data of AD and AS were extracted from genome-wide association studies(GWAS)by Mendelian randomization(MR),and inverse variance-weighted(IVW)analysis was used as main analysis,supplemented by weighted median,MR-Egger,weighted mode,etc,and verified by a series of sensitivity analyses.Results:IVW analysis of AD by AS:OR=1.015,95％CI:1.005～1.025,P=0.004.IVW analysis of AD for AS:OR=1.001,95％CI:1.000～1.002,P=0.120.Conclusion:AS has a statisti-cally small causal relationship on AD,and AD has no causal effect on AS.

Dilated cardiomyopathy(DCM)is a common disease leading to heart failure,arrhythmia,and sudden death.The etiology of DCM is complex and diverse,and the mechanisms have not been fully elucidated.Conventional interventions have a limited ability to improve the prognosis of patients,who have a 10-year survival rate of less than 25％.This study aimed to summarize the construction and characteristics of a DCM animal model and evaluate the clinical compatibility of the model with traditional Chinese and Western medicines.Analysis was based on domestic and overseas research into DCM animal models,Western clinical diagnostic criteria,and traditional Chinese medicine syndrome differentiation.The DCM modeling method mainly involved gene editing,drug induction,immune induction,viral infection,and rapid pacing induction.Experimental animals included muroids,zebrafish,Drosophila,and pigs,of which mice and rats were most commonly used.Gene editing was the most commonly used method for modelling DCM,followed by doxorubicin-induction.In the literature,the experimental animals,drugs,single or cumulative doses,administration method,and modeling period used varied among studies involving DCM animal models.The level of clinical anastomosis according to traditional Chinese and Western medicines varied considerably,being generally lower in traditional Chinese medicine than Western medicine in the same model.In addition,the modeling standards for DCM animal models were mostly based on Western medicine theories.The differentiation of syndrome models and information collection for the four diagnoses have not been standardized and unified.In the future,stable and homogeneous animal models of high clinical consistency combining both disease and syndrome need to be established to provide a basis for DCM mechanism research and drug development.

Dilated cardiomyopathy(DCM)is a common disease leading to heart failure,arrhythmia,and sudden death.The etiology of DCM is complex and diverse,and the mechanisms have not been fully elucidated.Conventional interventions have a limited ability to improve the prognosis of patients,who have a 10-year survival rate of less than 25％.This study aimed to summarize the construction and characteristics of a DCM animal model and evaluate the clinical compatibility of the model with traditional Chinese and Western medicines.Analysis was based on domestic and overseas research into DCM animal models,Western clinical diagnostic criteria,and traditional Chinese medicine syndrome differentiation.The DCM modeling method mainly involved gene editing,drug induction,immune induction,viral infection,and rapid pacing induction.Experimental animals included muroids,zebrafish,Drosophila,and pigs,of which mice and rats were most commonly used.Gene editing was the most commonly used method for modelling DCM,followed by doxorubicin-induction.In the literature,the experimental animals,drugs,single or cumulative doses,administration method,and modeling period used varied among studies involving DCM animal models.The level of clinical anastomosis according to traditional Chinese and Western medicines varied considerably,being generally lower in traditional Chinese medicine than Western medicine in the same model.In addition,the modeling standards for DCM animal models were mostly based on Western medicine theories.The differentiation of syndrome models and information collection for the four diagnoses have not been standardized and unified.In the future,stable and homogeneous animal models of high clinical consistency combining both disease and syndrome need to be established to provide a basis for DCM mechanism research and drug development.

ObjectiveTo establish and validate a clinical prediction model for 1-year major adverse cardiovascular events（MACEs）risk after percutaneous coronary intervention （PCI） in coronary heart disease （CHD） patients with blood stasis syndrome. MethodThe consecutive CHD patients diagnosed with blood stasis syndrome in the Department of Integrative Cardiology at China-Japan Friendship Hospital from September 1， 2019 to March 31， 2021 were selected for a retrospective study， and basic clinical features and relevant indicators were collected. Eligible patients were classified into a derivation set and a validation set at a ratio of 7∶3， and each set was further divided into a MACEs group and a non-MACEs group. The factors affecting the outcomes were screened out by least absolute shrinkage and selection operator （Lasso） and used to establish a logistic regression model and identify independent prediction variables. The goodness-of-fit of the model was evaluated by the Hosmer-Lemeshow test， and the area under curve （AUC） of the receiver operating characteristic （ROC） curve， calibration curve， decision curve analysis （DCA）， and clinical impact curve （CIC） were employed to evaluate the discrimination， calibration， and clinical impact of the model. ResultA total of 731 consecutive patients were assessed and 404 eligible patients were enrolled， including 283 patients in the derivation set and 121 patients in the validation set. Lasso identified ten variables influencing outcomes， which included age， sex， fasting plasma glucose （FPG）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， homocysteine （Hcy）， brachial-ankle pulse wave velocity （baPWV）， flow-mediated dilatation （FMD）， left ventricular ejection fraction （LVEF）， and Gensini score. The multivariate Logistic regression preliminarily identified age， FPG， TG， Hcy， LDL-C， LVEF， and Gensini score as the independent variables that influenced the outcomes. Of these variables， male， high FMD and high LVEF were protective factors， and the rest were risk factors. The prediction model for 1-year MACEs risk after PCI in CHD patients with blood stasis syndrome showed χ²=12.371 （P=0.14） in Hosmer-Lemeshow test and the AUC of 0.90. With the threshold probability > 10%， the model showed better prediction performance for 1-year MACEs risk after PCI in CHD patients with blood stasis syndrome than for that in all the patients. With the threshold probability > 60%， the estimated value was much closer to the real number of patients. ConclusionThe established clinical prediction model facilitates the early prediction of 1-year MACEs risk after PCI in CHD patients with blood stasis syndrome， which can provide ideas for the precise treatment of CHD patients after PCI and has guiding significance for improving the prognosis of the patients. Meanwhile， multi-center studies with larger sample sizes are expected to further validate， improve， and update the model.

Objective:To explore the risk factors of the incidence of arrhythmia and the prediction of baseline ventricular late potential in patients with first depression episode.Methods:The cohort study was used to observe the relationship between the baseline status of ventricular late potential, the severity of baseline depression symptoms, the extent of remission of depressive symptoms within the treatment duration and arrhythmia incidence in the 3 years progress. For the assessment of the severity of depression symptoms, 17 version of Hamilton depression scale was used to evaluate the baseline ventricular late potential, and DMS lab3.0 ECG platform late potential analysis system was used to determine the assessment (CardioScan 12 NET version). The first depression patients with positive ventricular late potential were followed up for 3 years. The changes of the severity of ventricular late potential and depression symptoms were investigated, and the correlation with the subsequent course of arrhythmia was investigated.SPSS 20.0 software package was used for statistical distraction, chi square test was used for count data, independent samples t test was used for normal distribution measurement data, Mann-Whitney U test was used for non-normal distribution count data, and logistic regression method was used to calculate relative risk( RR). Results:According to the 3-year follow-up of 400 first-episode depression patients, 22.25% (89/400) had malignant arrhythmia. The incidence of malignant arrhythmia was 39.46% (58/147) in ventricular late potential positive group and 12.25% (31/253) in ventricular late potential negative group, and the difference was statistically significant(χ 2=9.578, P<0.01). Logistic regression analysis showed that positive ventricular late potential at baseline (compared with negative ventricular late potential at baseline, RR=10.78, 95% CI=8.34-13.80), having a family history of arrhythmia (compared with no family history of arrhythmia, RR=5.23, 95% CI=2.41-9.85), had a higher severity of depression at baseline (compared with lower severity of depression at baseline, RR=1.73, 95% CI=1.25-2.85), poor first-time efficacy and more repeated hospitalizations (compared with good first-time efficacy and less hospitalizations, RR=1.11, 95% CI=1.04-1.17), and age of onset< 20 (compared with age of onset≥20, RR=1.07, 95% CI=1.02-1.93) were the risk factors of malignant arrhythmia in patients with first-episode depression(all P<0.05). Conclusion:The incidence of arrhythmia is very high in those patients with baseline positive late ventricular potential. Positive late ventricular potential, family history of arrhythmia, younger onset age and poor therapeutic effect were the relative risk of arrhythmia in the patients with depression.

An 82-year-old male patient with cerebral infarction received an IV infusion of cinepazide maleate 320 mg + 0. 9% sodium chloride injection once daily for 30 consecutive days. The patient' s neutrophil count(NEUT)was 5. 7 × 109 / L before treatments and 2. 4 × 109 / L on day 28 of treatments. An interval of 5 days later,cinepazide maleate was given again at the same dosage. On day 6 of second use of cinepazide maleate,the patient's NEUT decreased to 0. 2 × 109 / L. Cinepazide maleate was stopped and mecobalamin(500 μg,twice daily),folic acid(5 mg,once daily),and leucogen(20 mg,twice daily) were given. Two days later,the patient's NEUT decreased to 0. Recombinant human granulocyte colony stimulating factor 200 μg twice daily was injected subcutaneously. Two days later,the patient' s NEUT increased to 4. 5 × 109 / L. The patient received cinepazide maleate combined with 15 kinds of drugs at the same time because he suffered from several kinds of diseases. During 18 months of follow-up,the patient did not take cinepazide maleate again and most other combination drugs were used continuously and neutropenia did not recur. It was considered that cinepazide maleate induced the patient's acute agranulocytosis.

An 82-year-old male patient with cerebral infarction received an IV infusion of cinepazide maleate 320 mg + 0. 9% sodium chloride injection once daily for 30 consecutive days. The patient' s neutrophil count(NEUT)was 5. 7 × 109 / L before treatments and 2. 4 × 109 / L on day 28 of treatments. An interval of 5 days later,cinepazide maleate was given again at the same dosage. On day 6 of second use of cinepazide maleate,the patient's NEUT decreased to 0. 2 × 109 / L. Cinepazide maleate was stopped and mecobalamin(500 μg,twice daily),folic acid(5 mg,once daily),and leucogen(20 mg,twice daily) were given. Two days later,the patient's NEUT decreased to 0. Recombinant human granulocyte colony stimulating factor 200 μg twice daily was injected subcutaneously. Two days later,the patient' s NEUT increased to 4. 5 × 109 / L. The patient received cinepazide maleate combined with 15 kinds of drugs at the same time because he suffered from several kinds of diseases. During 18 months of follow-up,the patient did not take cinepazide maleate again and most other combination drugs were used continuously and neutropenia did not recur. It was considered that cinepazide maleate induced the patient's acute agranulocytosis.