Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)versus non-invasive positive pressure ventilation(NPPV)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)accompanied by mild to moderate hypercapnia.Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021,to October 2023,with 49 in the NPPV group and 43 in the HFNC group.The two groups were compared in terms of 28-day intubation rate,90-day mortality,and arterial blood gases.Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group(28.57％vs.11.63％,P<0.05),but no significant differences in the 90-day mortality rate(36.73％vs.23.26％,P>0.05).The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group(Log-Rank test:χ2=4.257,P=0.039),but no significant difference in 90-day mortality rate(Log-Rank test:χ2=2.596,P=0.107).A Cox proportional hazards model,which incorporated APACHE Ⅱ score and baseline PaCO2,demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69％as compared to the NPPV group(HR=0.31,95％CI:0.10～0.93,P=0.037),but the risk of 90-day mortality did not show a significant decrease(HR=0.61,95％CI:0.27～1.37,P=0.232).PaCO2 in both groups decreased gradually and pH increased simultaneously.PaCO2,pH,and PaO2 at 2h and 48h against the baseline values did not differ significantly between the two groups(P>0.05).Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia,HFNC reduces intubation rates compared to NPPV,without increasing mortality,and shows similar improvements in arterial blood gas indicators,making it a suitable respiratory support option.

Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)versus non-invasive positive pressure ventilation(NPPV)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)accompanied by mild to moderate hypercapnia.Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021,to October 2023,with 49 in the NPPV group and 43 in the HFNC group.The two groups were compared in terms of 28-day intubation rate,90-day mortality,and arterial blood gases.Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group(28.57％vs.11.63％,P<0.05),but no significant differences in the 90-day mortality rate(36.73％vs.23.26％,P>0.05).The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group(Log-Rank test:χ2=4.257,P=0.039),but no significant difference in 90-day mortality rate(Log-Rank test:χ2=2.596,P=0.107).A Cox proportional hazards model,which incorporated APACHE Ⅱ score and baseline PaCO2,demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69％as compared to the NPPV group(HR=0.31,95％CI:0.10～0.93,P=0.037),but the risk of 90-day mortality did not show a significant decrease(HR=0.61,95％CI:0.27～1.37,P=0.232).PaCO2 in both groups decreased gradually and pH increased simultaneously.PaCO2,pH,and PaO2 at 2h and 48h against the baseline values did not differ significantly between the two groups(P>0.05).Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia,HFNC reduces intubation rates compared to NPPV,without increasing mortality,and shows similar improvements in arterial blood gas indicators,making it a suitable respiratory support option.

Objective To investigate the clinical value of thromboelastography (TEG) in monitoring the coagulation function change after plasma supplementation in the patients with severe liver cirrhosis diges-tive tract hemorrhage.Methods A total of 48 patients with high risk and extreme high risk liver cirrhosis a-cute upper digestive hemorrhage receiving the treatment in ICU of this hospital from February 2020 to March 2023 were selected as the study subjects.After plasma infusion with the dose of 10 mL/kg,the coagulation function status was detected.The patients were divided into the TEG group (n=20) and the control group (n=28) according to different detection modes of coagulation function.The TEG group simultaneously detec-ted TEG and traditional coagulation function detection,while the control group only conducted the traditional coagulation detection.TEG and coagulation function detection indicators after the infusion of plasma were compared between the two groups.The plasma infusion amounts at 24 h after admitting in ICU were recorded and the control status of digestive tract hemorrhage was evaluated.Results The R value in the TEG group was (8.02±6.09)min,the K vale was 2.5(1.3,5.0)min,the coagulation comprehensive index (CI) was-4.70±6.29,the maximal shear stress coefficient (MA) was 50.35±18.84,LY30 was 0.The Pearson corre-lation analysis showed that MA was positively correlated with FIB and PLT (r=0.470,0.526,P<0.05),and the other indexes had no correlation.Compared with the control group,the plasma infusion amounts in the TEG group was more[(419.00±143.18)mL vs. (400.00±137.54)mL],the digestive tract hemorrhage con-trol rate was higher[75.00％(15/20) vs. 53.57％(15/28)],but the differences were not statistically signifi-cant (P>0.05).The multiple linear regression was MA=-3.427+11.200×Ln(PLT)+10.230×Ln(FIB).Con-clusion In the patients with severe lever cirrhosis acute upper gastrointestinal bleeding,TEG could earlier find the co-agulation function improvement situation after plasma supplementation than the traditional coagulation detection.

Objective To investigate the effect of lidocaine on the chemotherapy sensitivity of gastric cancer cells by regulating the Wnt/β-catenin axis. Methods Human gastric cancer cells SGC-7901 in logarithmic growth phase were inoculated into 96-well plates and treated with different concentrations of lidocaine (0, 10, 50, 100, 150, 200 μmol/L) for 24 h. The cell viability at different concentrations was compared. The SGC-7901 cells in logarithmic growth phase were divided into control group, cisplatin group, low concentration lidocaine group (Lido-L group), medium concentration lidocaine group (Lido-M group), high concentration lidocaine group (Lido-H group), high concentration lidocaine + Wnt/β-catenin signal pathway activator SKL2001 group (Lido-H+SKL2001 group). The cell proliferation, invasion, and migration abilities of each group were compared by 5-acetylidene-2'deoxyuracil nucleoside (EdU) cell proliferation detection, Transwell assay, and scratch healing experiment. The apoptosis of each group was detected by TUNEL assay. The expressions of apoptosis, epithelial-mesenchymal transition, and Wnt/β-catenin pathway-related proteins in each group were detected. Results Compared with 0 μmol/L lidocaine, the cell viability of SGC-7901 cells treated with 50, 100, 150, and 200 μmol/L lidocaine was reduced (P < 0.05). Compared with the control group, the EdU positive rate, the number of cell invasion, scratch healing rate, and expressions of vimentin, N-cadherin, B-cell lymphoma-associated protein-2 (Bcl-2), cyclin D1, scattered protein 2 (DVL2), Wnt family member 3a (Wnt3a), β-catenin (β-catenin) were reduced in the cisplatin group, while the cell apoptosis rate was increased, the expressions of E-cadherin, B-cell lymphoma-2-associated X protein (Bax), Cleaved-caspase-3 were increased, and the differences were statistically significant (P < 0.05). Compared with the cisplatin group, the EdU positive rate, the number of cell invasion, scratch healing rate, and expressions of vimentin, N-cadherin, Bcl-2, cyclin Dl, DVL2, Wnt3a, β-catenin were gradually reduced in the Lido-L group, Lido-M group, and Lido-H group, while the cell apoptosis rate, the expressions of E-cadherin, B-cell lymphoma-2-associated X protein (Bax), Cleaved-caspase-3 were increased (P < 0.05). Compared with the Lido-H group, the EdU positive rate, the number of cell invasion, scratch healing rate, and expressions of vimentin, N-cadherin, Bcl-2, cyclin Dl, DVL2, Wnt3a, β-catenin were increased in the Lido-H+SKL2001 group, while the cell apoptosis rate and expressions of E-cadherin, Bax, Cleaved-caspase-3 were reduced, the differences were statistically significant (P < 0.05). Conclusion Lidocaine may enhance the chemotherapy sensitivity of gastric cancer cells by inhibiting the activation of the Wnt/β-catenin axis.

Tea green leafhopper(TGL),Empoasca onukii,is of biological and economic interest.Despite numerous studies,the mechanisms underlying its adaptation and evolution remain enig-matic.Here,we use previously untapped genome and population genetics approaches to examine how the pest adapted to different environmental variables and thus has expanded geographically.We complete a chromosome-level assembly and annotation of the E.onukii genome,showing nota-ble expansions of gene families associated with adaptation to chemoreception and detoxification.Genomic signals indicating balancing selection highlight metabolic pathways involved in adaptation to a wide range of tea varieties grown across ecologically diverse regions.Patterns of genetic vari-ations among 54 E.onukii samples unveil the population structure and evolutionary history across different tea-growing regions in China.Our results demonstrate that the genomic changes in key pathways,including those linked to metabolism,circadian rhythms,and immune system functions,may underlie the successful spread and adaptation of E.onukii.This work highlights the genetic and molecular basis underlying the evolutionary success of a species with broad economic impacts,and provides insights into insect adaptation to host plants,which will ultimately facilitate more sustain-able pest management.

OBJECTIVE： To prepare Capsaicin solid dispersion， to optimize its formulation and characterize the dispersion. METHODS： Capsaicin solid dispersion was prepared by melting method using P188 or PEG4000 as carrier. Using 60 min accumulative dissolution rate in vitro as index， orthogonal test was used to optimize type of carrier， drug ratio and stirring time. Validation test was conducted. The stability of Capsaicin solid dispersion within 0， 30， 180 d was investigated at 40 ℃ under the relative humidity of 75％， and X-ray diffraction （XRD） was used to analyze whether there were peaks. Capsaicin solid dispersion was characterized by differential scanning calorimetry （DSC） and XRD. RESULTS： The optimized formula included P188-PEG4000 as carrier， capsaicin-P188-PEG 4000 mass ratio of 1 ∶ 5 ∶ 3， stirring for 20 min. Accumulative dissolution rate in vitro of Capsaicin solid dispersion was 84.6％ within 60 min （n＝3）， and the preparation kept stable within 180 d [RSD of content was 3％ （n＝3）； XRD showed that there was no peak]. The phase characteristics showed that capsaicin was highly dispersed in the amorphous or molecular state in carrier. CONCLUSIONS： The optimized technology can be used to prepare Capsaicin solid dispersion， and improves more than 80％ dissolution rate in vitro at 60 min. It is stable， simple and feasible.

Objective To establish a test of autoantibody-panel for the diagnosis of autoimmune cerebellitis (AC) and determine the prevalence of AC in patients with cerebellar ataxia of unknown etiology.Methods Autoantibody screening tests with indirect immunofluorescence were performed in serum and cerebrospinal fluid (CSF) samples of 400 previously'idiopathic'Chinese patients with cerebral ataxia (inpatients and outpatients in Peking Union Medical College Hospital or referred from hospitals of Beijing Encephalitis Group from 2016 to 2018).Immunotherapy was given to autoantibody positive patients and the effectiveness of immunotherapy was assessed.Detailed AC autoantibodies panel included anti-glutamate decarboxylase 65 (GAD65) antibody,anti-Tr (delta notch-like epidermal growth factor-related receptor (DNER)) antibody,anti-zinc finger protein 4 (ZIC4) antibody,anti-inositol 1,4,5-trisphosphate receptor 1 (ITPR1) antibody,anti-homer protein homolog 3 (Homer 3) antibody,anti-neurochondrin (NCDN) antibody,anti-carbonic anhydrase-related protein (CARP) antibody and anti-Purkinje cell antibody 2 (PCA2) antibody.Results Eight out of 400 (2％) ataxia patients were positive for this AC panel tests,of whom two were positive for anti-GAD65 antibody,two for anti-Tr antibody,one for anti-PCA2 antibody,one for anti-Homer 3 antibody and two were positive for serum anti-NCDN antibody.Autoantibodies against ZIC4,ITPR1 and CARP were not detected in this cohort.Two of the eight ataxia patients also presented with limbic encephalitis,and only one anti-GAD antibody patient was screened with underlying small cell lung carcinoma (SCLC).All the eight patients received immunotherapy and four experienced partial response.Conclusions Autoimmune cerebellitis is the cause of acquired cerebellar ataxia.Tests of autoantibodies associated with AC have diagnostic value for paraneoplastic and non-paraneoplastic cerebellar ataxia.Immunotherapy may yield partial response in patients with AC.

Through the problem of gene-related clinical and scientific studies reviewed by the Institutional Review Board (IRB), Shanghai Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, this article discussed and summarized main points of clinical gene-related studies such as participants have indepen-dent rights, which were the choice of being told the research results and the donors of Biobank have rights for option in or out. The clinical gene-related studies should pay attention to the protection of genetic resources dur-ing the study, fairness of genetic research findings' usage. And on this basis, in order to facilitate the effective operation of the researchers, key elements of the gene-related research projects were developed in the design plan and informed consent. Finally, the importance and implementation of relevant standardization system construction were also emphasized .

This paper explored the joint teaching model between universities and hospitals.Clinical practice teaching based on medical ethics was carried out,choosing academic leader of teaching and research section of medical ethics as the core and relying on ethic committee of affiliated hospital as the support.Three teaching methods were integrated:theoretical introduction-case analysis-multi-role discussion(doctor,patient's organization,medical ethic specialist),which rendered ethical teaching more practical and operational.Facing the dilemma of present hospital environment,introducing medical ethic and other human sciences into clinical practices and other medical organization was evidently a better choice than strengthening police forces in hospital.

Expressions of interleukin-6 (IL-6) and its receptor (gp80、gp130) in 8 patients with Graves' disease (GD) were compared with those in 8 euthyroid patients with nodular goiter or benign thyroid adenoma. The thyroid tissues of GD expressed significantly higher IL-6 mRNA, gp130 mRNA and IL-6 protein than those of the control group, suggesting that activated IL-6/gp130 signal pathway in the thyroid tissue may contribute to the pathogenesis of GD.