ObjectiveTo evaluate the clinical efficacy of Shenqi Yangxin decoction in the treatment of ischemic cardiomyopathy （ICM） with Qi and Yin deficiency and blood stasis syndrome and its effect on serum hydrogen sulfide （H₂S） and calcium ion （Ca²⁺）. MethodsA total of 64 ICM patients with Qi and Yin deficiency and blood stasis syndrome who met the inclusion criteria were randomly divided into a control group （n=32） and a treatment group （n=32）. All patients received conventional Western medicine treatment. The treatment group was additionally given Shenqi Yangxin decoction. The TCM syndrome score， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， left ventricular ejection fraction （LVEF）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， 6-minute walk test （6MWT）， New York Heart Association （NYHA） cardiac function classification， and serum H₂S and Ca²⁺ levels were compared between the two groups pre- and post-treatment. ResultsTwo cases dropped out from each group during the study. Finally， 30 patients in each group were included in the analysis. There were no significant differences in age， gender， course of coronary heart disease， underlying diseases， and laboratory tests between the two groups. Compared with baseline， the TCM syndrome score， MLHFQ score， and NT-proBNP in both treatment group and control group decreased significantly （P<0.01）， LVEF， 6MWT， and H₂S increased significantly （P<0.01）， and serum Ca²⁺ increased （P<0.05）. Compared with the control group after treatment， the MLHFQ score and NT-proBNP in the treatment group decreased （P<0.05）， the TCM syndrome score decreased significantly （P<0.01）， LVEF， 6MWT， and serum Ca²⁺ increased （P<0.05）， and H₂S increased significantly （P<0.01）. The improvement degree of the NYHA cardiac function classification in the treatment group was higher than that in the control group， but there was no significant difference. ConclusionShenqi Yangxin decoction is effective in treating ICM patients with Qi and Yin deficiency and blood stasis， which could significantly improve cardiac function and quality of life， and its therapeutic effect may be related to the regulation of serum H₂S and Ca²⁺ levels.

Background and Aims:Early-onset extensive emphysematous pancreatitis(EP)is a rare but highly lethal subtype of infected pancreatic necrosis(IPN),characterized by abrupt onset and rapid deterioration.This study aimed to investigate its clinical characteristics,microbiological spectrum,treatment approaches,and outcomes to provide evidence for early identification and timely intervention.Methods:A retrospective analysis was performed on 305 IPN patients treated at Xiangya Hospital,Central South University,from January 2010 to October 2023.Eight patients who developed gas accumulation involving≥50%of pancreatic or peripancreatic necrosis within two weeks of onset were defined as early-onset extensive EP.Their clinical data were compared with those of ordinary IPN patients.Results:Early-onset extensive EP accounted for 2.6%of all IPN cases.The early-onset extensive EP group had significantly higher mortality and multiple organ failure rates compared with the ordinary IPN group(75.0%vs.24.6%and 75.0%vs.34.7%,respectively;both P<0.05).A total of 15 microbial isolates were identified from early-onset extensive EP patients,predominantly Klebsiella pneumoniae(62.5%)and Escherichia coli(37.5%).The infection rate of carbapenem-resistant Enterobacteriaceae(CRE)was markedly higher in the EP group than in the ordinary IPN group(75.0%vs.31.1%,P=0.015).Most patients were treated using a step-up approach based on percutaneous catheter drainage,with no significant difference in treatment strategy between the two groups(P=0.625).Conclusion:Early-onset extensive EP represents a rare and fulminant subtype of IPN with extremely poor outcomes.Klebsiella pneumoniae and CRE are the predominant pathogens.Early radiological evaluation and timely intervention are crucial for improving prognosis in these patients.

In the context of medical insurance payment reform,the sample hospital has implemented performance management optimization to effectively address the challenges posed by diagnosis-intervention packet(DIP)payment.Reform measures focused on disease quality,rational diagnosis and treatment,operational management,medical technological value,and policy orientation,and they have significantly optimized service ability and performance evaluation indexes of the hospital.Main achievements included a reduction in the cost consumption index and an increase in the clinical performance index,with the overall DIP payment rate increasing from 88.86%to 103.23%and a marked improvement in operational management.The quality control and operational efficiency of the hospital have been effectively enhanced by choosing proper DIP payment evaluation indexes and improving performance management,and provided strong support for the high-quality development of the hospital.

Objective To investigate the effect of Gd-hydroxyapatite(Gd-HA)stents with adipose mesenchymal cells(ADSCs)on the repair of knee articular cartilage defects.Methods To isolate,culture,and identify rabbit ADSCs by establishing a rabbit knee joint full-thickness cartilage defect model,a total of 18 rabbits were randomly divided into blank control group,Gd-HA scaffold group,and ADSCs+Gd-HA scaffold group.At week 12 and 24 after surgery,International Curtilage Repair Society(ICRS)score,HE,toluidine blue,modified red O bright green and ColⅡ were detected by immunohistochemical staining,then ColⅡand GAG mRNA expression levels were detected by O'Driscoll and Real-time PCR.ColⅡ protein expression was detected by Western blotting,GAG content was detected by DMMB,biomechanical strength was detected by indentation test,and PKH26 labeled ADSCs was used to trace the tissue engineering scaffold with Gd-HA composite ADSCs to evaluate the repair effect of rabbit knee cartilage defects.Results The ADSCs isolated and cultured in vitro showed good growth,stable phenotype and good directional differentiation through macroscopic observation and histological staining,it could be seen that the repair degree and effect of the knee joint full-thickness cartilage defect model implanted with Gd-HA scaffold group were better than those of the blank control group,while the cartilage repair situation of the ADSCs+Gd-HA scaffold group was better than that of the Gd-HA scaffold group(P＜0.05);The ICRS and improved O'Driscoll scores were higher than the other two groups(P＜0.05).Compared with the Gd-HA group,the ADSCs+Gd-HA group could produce ColⅡ and GAG during the process of cartilage repair,with stronger mechanical strength of the repaired tissue(P＜0.05);PKH26 labeled ADSCs were found in the repaired tissues of the ADSCs+Gd-HA group,and they were involved in the composition of newly formed tissues.Conclusion Gd-HA scaffold material combined with ADSCs has a good repair effect on full-thickness cartilage defects in the knee joint as a new type of biological material for repairing joint cartilage defects.

Objective To investigate the effect of long non-coding RNA Jumonji C domain con-taining histone demethylase 1 homolog D antisense RNA1(lncRNA JHDM1D-AS1)targeting microR-NA-421(miR-421)on hydrogen peroxide(H2O2)induced oxidative damage in cardiomyocytes(H9C2 cells).Methods H9C2 cells were divided into control(Con)group,H2O2 group,H2O2+pcDNA group,H2O2+pcDNA-JHDM1D-AS1 group,H2O2+anti-miR-NC group,H2O2+anti-miR-421 group,H2O2+pcDNA-JHDM1D-AS1+miR-NC group,and H2O2+pcDNA-JHDM1D-AS1+miR-421 group.The expressions of JHDM1D-AS1 and mi R-421 were detected by real-time fluorescent quantitative PCR(RT-qPCR).The superoxide dismutase(SOD)activity,malondialdehyde(MDA)level,and lactate dehydrogenase(LDH)level in the culture medium of H9C2 cells were measured by colorimetry.Flow cytometry was used to evaluate the apoptosis rate of H9C2 cells.The targeting rela-tionship between JHDM1D-AS1 and mi R-421 was verified by dual luciferase reporter gene assay.Re-sults Compared with the Con group,the H2O2 group showed decreased levels of JHDM1D-AS1 and SOD activity,and increased levels of MDA,LDH,apoptosis rate,and miR-421 in H9C2 cells,with significant between-group differences(P＜0.05).Compared with the H2O2+pcDNA group,the H2O2+pcDNA-JHDM1D-AS1 group exhibited increased SOD activity and decreased miR-421 ex-pression level,MDA level,LDH level,and apoptosis rate in H9C2 cells,with significant between-group differences(P＜0.05).Compared with the H2O2+anti-miR-NC group,the H2O2+anti-miR-421 group showed increased SOD activity and decreased MDA level,LDH level,and apoptosis rate in H9C2 cells,with significant between-group differences(P＜0.05).MiR-421 was identified as a target gene of JHDM1D-AS1.Compared with the H2O2+pcDNA-JHDM1D-AS1+miR-NC group,the H2O2+pcDNA-JHDM1D-AS1+miR-421 group exhibited decreased SOD activity and in-creased MDA level,LDH level,and apoptosis rate in H9C2 cells,with significant between-group differences(P＜0.05).Conclusion LncRNA JHDM1D-AS1 inhibits apoptosis and oxidative stress by targeting and downregulating miR-421 expression,thereby alleviating H2O2-induced oxida-tive damage in cardiomyocytes.

Objective To evaluate the clinical value and safety of double nylon rope purse string suture closing the postoperative wounds of the treatment of endoscopic full thickness resection(EFR)for gastric submucosal tumors(SMT).Methods We retrospectively analyzed the clinical data of 104 patients with gastric SMT originating from the muscularis propria,from June 2020 to March 2023.According to different suture methods,they were divided into single nylon rope purse string suture group(48 cases)and double nylon rope purse string suture group(56 cases).The patients'operative,postoperative,and long-term follow-up conditions were evaluated.Results All tumors were completely resected under endoscopic guidance.The terms of lesion diameter in double nylon rope purse string suture group was bigger than that in single nylon rope purse string suture group,there was statistically significant difference between the two groups(P=0.040).In the single nylon rope purse string suture group,postoperative perforation occurred in 1 case,low fever occurred in 4 cases,and mild pain in the upper abdomen occurred in 6 cases,in the double nylon rope purse string suture group,there was no postoperative perforation,5 patients had low fever,and 6 patients had mild pain in the upper abdomen,there was no significant difference in postoperative complications between the two groups(P＞0.05).No postoperative cases were transferred to gastrointestinal surgery,and all patients were discharged smoothly.After 3 months,7 cases in the single nylon rope purse string suture group had titanium clips and/or nylon rope residue,while 18 cases in the double nylon rope purse string suture group still had titanium clips and/or nylon rope residue,and the difference between the two groups was statistically significant(P=0.037).Conclusion Compared with single nylon rope purse string suture,double nylon rope purse string suture can effectively close the postoperative wounds following gastric SMT with EFR(≥3 cm).

Background and Aims:Early-onset extensive emphysematous pancreatitis(EP)is a rare but highly lethal subtype of infected pancreatic necrosis(IPN),characterized by abrupt onset and rapid deterioration.This study aimed to investigate its clinical characteristics,microbiological spectrum,treatment approaches,and outcomes to provide evidence for early identification and timely intervention.Methods:A retrospective analysis was performed on 305 IPN patients treated at Xiangya Hospital,Central South University,from January 2010 to October 2023.Eight patients who developed gas accumulation involving≥50%of pancreatic or peripancreatic necrosis within two weeks of onset were defined as early-onset extensive EP.Their clinical data were compared with those of ordinary IPN patients.Results:Early-onset extensive EP accounted for 2.6%of all IPN cases.The early-onset extensive EP group had significantly higher mortality and multiple organ failure rates compared with the ordinary IPN group(75.0%vs.24.6%and 75.0%vs.34.7%,respectively;both P<0.05).A total of 15 microbial isolates were identified from early-onset extensive EP patients,predominantly Klebsiella pneumoniae(62.5%)and Escherichia coli(37.5%).The infection rate of carbapenem-resistant Enterobacteriaceae(CRE)was markedly higher in the EP group than in the ordinary IPN group(75.0%vs.31.1%,P=0.015).Most patients were treated using a step-up approach based on percutaneous catheter drainage,with no significant difference in treatment strategy between the two groups(P=0.625).Conclusion:Early-onset extensive EP represents a rare and fulminant subtype of IPN with extremely poor outcomes.Klebsiella pneumoniae and CRE are the predominant pathogens.Early radiological evaluation and timely intervention are crucial for improving prognosis in these patients.

OBJECTIVE To investigate the management status of small pressure steam sterilizers in dental institu-tions across seven major regions of China and provide references for establishing standardized monitoring and eval-uation protocols for sterilization efficacy.METHODS From Aug.to Nov.2023,a convenience sampling method was employed to select 885 dental institutions of various levels from seven geographical regions.An online survey using a self-designed questionnaire was conducted to assess the management status of small pressure steam steri-lizers in dental institutions.RESULTS A total of 885 questionnaires were distributed,with 770 valid responses col-lected,covering 770 dental institutions at all levels.The survey involved 2 056 small pressure steam sterilizers,of which 43.14％were pre-vacuum type and 89.40％were benchtop models.Tertiary dental institutions had the high-est proportion of imported small pressure steam sterilizers(60.15％),with most devices in use for 5-10 years(36.88％).Secondary and low er-level institutions predominantly used domestically produced small pressure steam sterilizers(74.60％),which used for 3-5 years accounting for the highest proportion(34.29％).While 85.58％of dental institutions employed dedicated sterilization personnel,only 45.84％performed proper maintenance for small pressure steam sterilizers.Training rates were 80.00％for department of stomatology in ungraded general hospitals and primary medical institutions,76.19％in prejob and 71.43％during the work for department of sto-matology in primary clinics,respectively.CONCLUSIONS Although most dental institutions demonstrate sound policy formulation,challenges persist in equipment maintenance,policy implementation and grassroots training.Future efforts should be made on strengthening maintenance and inspection of equipment,enhancing sys-tem supervisory mechanisms,and optimizing training systems to ensure dental treatment safety.

Objective To investigate the post-intervention experiences in elderly stroke patients who received the group-based acceptance and commitment therapy(ACT)and to provide a reference to improve the group-based ACT intervention strategies for the patients.Methods With the descriptive phenomenological research,the semi-structured in-depth interviews were conducted with 15 elderly stroke patients who had received the group-based ACT intervention for 6 months in a Tier-IIIA hospital in Hunan Province between May and July 2023.The data acquired from the interviews were analysed using the Colaizzi method.Results The experiences in elderly stroke patients with the group-based ACT intervention were categorised into three main themes and ten sub-themes:(1)The impact of intervention on the psychology and spirit(change cognition and accept oneself;enhance awareness and reflect on oneself;clarify values and adapt to oneself;disengage from suffering and achieve dissociation;understand suffering and discover a sense of meaning in life);(2)Behavioural changes brought by the intervention(change approaches to improve health;engage in rehabilitation exercises and build confidence;enhance social interactions and integrate into life);(3)Suggestions for the intervention program(tailor to the physiological characteristics of the elderly;adapt to the psychological characteristics of the elderly).Conclusion The group-based ACT intervention has a beneficial effect on the psychological,spiritual and behavioural changes in the elderly stroke patients.The intervention programs should be improved according to the physical and mental characteristics therefore to improve the mental health of elderly stroke patients.

Objective To standardize and enhance the cleanliness of hospital floor and cleaning tools,significantly re-duce the influence of the predisposing factors that easily cause hospital-acquired infectious events,and reduce the possibility of such events due to inadequate cleaning and hygiene practices.Methods This study used Guangdong Second Provincial General Hospital as the research subject,cleaning tools were washed using both traditional manual disinfection and centralized mechanical cleaning and disinfection methods.Relevant experimental data were collected and compared to determine which method was more effective in terms of cleaning quality and optimal utilization of human resources.Results The bacterial colony count of floor tow-els treated with centralized mechanical cleaning and disinfection[(2.34±0.78)cfu/cm2]was significantly lower than that of the traditional manual cleaning group[(32.34±15.63)cfu/cm2].Similarly,the bacterial colony count on the floor cleaned with me-chanically centralized disinfected towels[(4.75±1.58)cfu/cm2]was much lower than that of the traditional manual disinfection group[(17.74±10.21)cfu/cm2)].Additionally,the bacterial colony count on door handles treated with centralized mechanical disinfection[(2.8±1.2)cfu/cm2]was significantly lower than that of the manual method[(10.1±5.7)cfu/cm2].Conclusion The centralized mechanical cleaning and disinfection method significantly mitigates the risk of hospital-acquired infections caused by insufficient disinfection of cleaning tools,while improving both the efficiency and quality of sanitation processes.