Objective To investigate the efficacy of preprocedural intracoronary injections of adenosine and sodium nitroprusside in patients with intravascular ultrasound-attenuated plaques(AP).Methods In total,200 patients with AP detected using intravascular ultrasound(IVUS)at Shijiazhuang People's Hospital from January 1,2022,to January 1,2024,were selected and randomly divided into conventional treatment and pretreatment groups,with 100 patients in each group.The conventional treatment group underwent standard percutaneous coronary intervention(PCI)procedures,whereas the pretreatment group underwent intracoronary injection of sodium nitro-prusside and adenosine through a guiding catheter prior to PCI.The observation parameters included intraoperative no-reflow(NR)inci-dence,post-PCI TIMI myocardial perfusion frame count(TMPFC),perioperative myocardial infarction(PMN),and 6-month major adverse cardiac and cerebrovascular events(MACCE).Results The pretreatment group exhibited a significantly lower intraoperative NR inci-dence,reduced postoperative TMPFC,and attenuated PMN severity than the conventional treatment group(P＜0.05).Conclusion Pre-procedural intracoronary administration of adenosine and sodium nitroprusside through a guiding catheter can effectively reduce PCI-re-lated NR occurrence,improve post-PCI TMPFC,and mitigate PMN in patients with AP,although no significant improvement in MACCE incidence can be observed at the 6-month follow-up.

OBJECTIVE To evaluate the economic burden of the intensive care unit(ICU)patients due to hospital-associated multidrug-resistant organisms(MDROs)infections based on propensity score matching(PSM)so as to provide evidence-based bases for prevention and control of hospital-associated MDROs infection and improvement of utilization efficiency of medical resources.METHODS A total of 2118 patients who were hospitalized in Zibo Central Hospital from Jan.1,2023 to Dec.31,2024 and conformed to the inclusion and exclusion criteria were re-cruited as the research subjects.The patients with hospital-associated MDROs infections were matched in a 1∶1 ratio by PSM(with the clamp value 0.02).Totally 309 pairs were successfully matched.The length of hospital stay and the costs were observed and compared between the MDROs group and the non-MDROs group.RESULTS The MDROs group was with the length of hospital stay 14.00 days longer than the non-MDROs group after the matching(Z=-5.750,P＜0.001),with the total cost of hospitalization increased by 91,420.84 yuan(Z=-8.271,P＜0.001).With the respect to the medical treatment expenses,the expenses of the MDROs group were higher than those of the non-MDROs group,covering the cost of medical service,therapeutic procedures,nursing,western medicine and TCM,and there were significant differences(P＜0.05).Among the differences in the costs between the two groups,the difference in the cost of western medicine was the most signif-icant(22,182.91 yuan),followed by the cost of clinical laboratory test for diagnosis(19,529.60 yuan)and the cost of therapeutic procedures(16,333.50 yuan).CONCLUSIONS The hospital-associated MDROs infections may lead to the extension of hospital stay length of the ICU patients,which then increases the economic burden.There-fore,it is necessary to strengthen the multidisciplinary collaboration and formulate corresponding measures so as to reduce the risk of such infections among the ICU patients.

Objective:To compare the dose-response effects of single-fraction ultra-high dose rate (FLASH) and conventional dose rate (CONV) whole abdominal irradiation (WAI) with X-rays on acute radiation-induced intestinal injury in mice, in order to identify optimal dose parameters and potential mechanisms.Methods:A total of 186 male C57BL/6J mice were randomly assigned to a non-irradiation group ( n=6), FLASH irradiation groups ( n=90), and CONV irradiation groups ( n=90). Acute radiation-induced intestinal injury models were established using single-fraction WAI with 11, 12, 13, 14, and 15 Gy X-rays (200 Gy/s for FLASH and 4 Gy/min for CONV). Changes in body weight, stool characteristics, and disease activity index (DAI) scores were assessed at 9 d post-irradiation. At 7 d post-irradiation at 11, 12, and 13 Gy, the intestines were collected for macroscopic examination and length measurement. The small intestine was selected for HE staining and quantitative analysis of intestinal crypt number and mucosal epithelial thickness. The survival of mice was assessed at 15 d post-WAI across all dose groups. Results:After single-fraction WAI at 11, 12, and 13 Gy, the body weight was higher in the FLASH group than that in the CONV group ( t=10.17, 12.65, 10.16, P<0.05). The DAI scores for the FLASH group were 1.00±1.10, 3.17±0.75, and 2.83±1.17, respectively, which were lower than those of the CONV group (4.33±0.52, 7.00±0.00, 8.60±0.55; t=8.70, 11.71, 14.99, P<0.05). However, after WAI at 14 Gy and 15 Gy, there were no significant differences in body weight and DAI between the FLASH group and the CONV group ( P>0.05). At 7 d after single-fraction WAI at 11, 12, and 13 Gy, mice in the FLASH group exhibited less intestinal congestion, edema, and shortening compared with the CONV group. The difference between the FLASH and CONV groups were statistically significant in small intestine length at 11 and 13 Gy ( t=4.42, 3.78, P<0.05), and in colorectal length at 11 and 12 Gy ( t=3.97, 3.12, P<0.05). Small intestine HE staining revealed superior preservation of intestinal architecture in the FLASH group compared with the CONV group, characterized by longer villi, increased crypt numbers, thicker mucosal epithelium, and enhanced structural integrity. The differences in crypt number and mucosal epithelial thickness were statistically significant ( tcrypt=13.10, 23.80, 11.90; tmucosal=5.75, 2.64, 7.74; P<0.05). At 15 d post-irradiation, the survival rate in the 15 Gy FLASH group was higher than that in the CONV group (50% vs. 10%, χ2=5.39, P<0.05), with a median survival extension of 6 d ( HR=0.340, 95% CI: 0.115 4-0.999 9). No significant survival differences were observed between the FLASH group and the CONV group at 11, 12, 13, and 14 Gy ( P>0.05). Conclusions:FLASH irradiation significantly alleviated acute radiation-induced intestinal injury from medium single-fraction WAI with 11, 12, and 13 Gy X-rays compared with CONV irradiation, and showed potential to improve mouse survival after single-fraction WAI at 15 Gy. This effect is likely associated with the preservation of intestinal crypts and exhibits a dose-dependent relationship.

BACKGROUND:A large number of studies have found that pyroptosis is closely related to the occurrence and development of motor system diseases,but there are few studies and reviews on pyroptosis in motor system diseases.OBJECTIVE:To review the current clinical and preclinical studies,summarize the role of pyroptosis in motor system diseases and related molecular mechanisms,and provide reference for the pyroptosis-targeted treatment for motor system diseases in the future.METHODS:The relevant literatures in PubMed and CNKI database were searched by computer from January 2000 to January 2024.The English search terms were"pyroptosis,tendons,ligaments,cartilage,muscles,bones"and the Chinese search terms were"pyroptosis,tendon,ligament,cartilage,skeletal muscle,bone"in Chinese.A combination of subject terms and free search terms was used.There were a total of 422 documents,including 334 in English and 88 in Chinese.After excluding duplicate literature and irrelevant literature,the literature without inclusion value was further excluded by reading the whole paper,and finally 78 documents were included for review and analysis.RESULTS AND CONCLUSION:Different pathways of pyroptosis and subsequent inflammatory responses can affect the progression of motor system diseases and the repair process of injuries.Excessive pyroptosis can not only cause a large number of tissue cells to die,but also aggravate tissue inflammation and degrade the extracellular matrix through substances such as inflammatory factors released after cell lysis,and damaging related molecular patterns can act as upstream signals to further aggravate pyroptosis.Current methods for preventing and treating motor system diseases mainly include NOD-like receptor thermal protein domain-associated protein 3 inhibitors,Chinese herbal extracts,exosome therapy,mesenchymal stem cell therapy,and exercise therapy.The review suggests that targeted intervention of some key factors in the process of pyroptosis may be a new direction for the treatment and prevention of motor system diseases.

In traditional Chinese medicine,jaundice is a liver and gallbladder disorder,primarily characterized by yellowing of the eyes,skin,and urine,with ocular yellowing being the most prominent feature.The understanding of jaundice pathogenesis in traditional Chinese medicine can be traced back to the Inner Canon of Huangdi.Despite the continuous development and improvement of successive generations of medical practitioners and a rich theoretical understanding of its pathogenesis being formed by the end of the Qing Dynasty,no unified view exists on whether the core pathological factor was dampness or blood stasis,nor on whether the primary disease location lay in the spleen and stomach or the liver and gallbladder.This article re-examines historical perspectives on jaundice pathogenesis within the context of traditional Chinese medicine theory,focusing on two key issues:pathological factors and the location of Zang and Fu.By integrating modern research approaches based on compound pathogenesis theory,and considering pathological factors,disease location according to Zang and Fu,and disease progression,a theoretical model is reconstructed,centered on the intermingling of dampness and blood stasis and integration of liver and spleen.Additionally,the insights and therapeutic strategies of multiple renowned clinical hepatology experts are incorporated to enrich the theoretical framework for jaundice treatment in traditional Chinese medicine and to enhance clinical efficacy.

In traditional Chinese medicine,jaundice is a liver and gallbladder disorder,primarily characterized by yellowing of the eyes,skin,and urine,with ocular yellowing being the most prominent feature.The understanding of jaundice pathogenesis in traditional Chinese medicine can be traced back to the Inner Canon of Huangdi.Despite the continuous development and improvement of successive generations of medical practitioners and a rich theoretical understanding of its pathogenesis being formed by the end of the Qing Dynasty,no unified view exists on whether the core pathological factor was dampness or blood stasis,nor on whether the primary disease location lay in the spleen and stomach or the liver and gallbladder.This article re-examines historical perspectives on jaundice pathogenesis within the context of traditional Chinese medicine theory,focusing on two key issues:pathological factors and the location of Zang and Fu.By integrating modern research approaches based on compound pathogenesis theory,and considering pathological factors,disease location according to Zang and Fu,and disease progression,a theoretical model is reconstructed,centered on the intermingling of dampness and blood stasis and integration of liver and spleen.Additionally,the insights and therapeutic strategies of multiple renowned clinical hepatology experts are incorporated to enrich the theoretical framework for jaundice treatment in traditional Chinese medicine and to enhance clinical efficacy.

Objective:To compare the dose-response effects of single-fraction ultra-high dose rate (FLASH) and conventional dose rate (CONV) whole abdominal irradiation (WAI) with X-rays on acute radiation-induced intestinal injury in mice, in order to identify optimal dose parameters and potential mechanisms.Methods:A total of 186 male C57BL/6J mice were randomly assigned to a non-irradiation group ( n=6), FLASH irradiation groups ( n=90), and CONV irradiation groups ( n=90). Acute radiation-induced intestinal injury models were established using single-fraction WAI with 11, 12, 13, 14, and 15 Gy X-rays (200 Gy/s for FLASH and 4 Gy/min for CONV). Changes in body weight, stool characteristics, and disease activity index (DAI) scores were assessed at 9 d post-irradiation. At 7 d post-irradiation at 11, 12, and 13 Gy, the intestines were collected for macroscopic examination and length measurement. The small intestine was selected for HE staining and quantitative analysis of intestinal crypt number and mucosal epithelial thickness. The survival of mice was assessed at 15 d post-WAI across all dose groups. Results:After single-fraction WAI at 11, 12, and 13 Gy, the body weight was higher in the FLASH group than that in the CONV group ( t=10.17, 12.65, 10.16, P<0.05). The DAI scores for the FLASH group were 1.00±1.10, 3.17±0.75, and 2.83±1.17, respectively, which were lower than those of the CONV group (4.33±0.52, 7.00±0.00, 8.60±0.55; t=8.70, 11.71, 14.99, P<0.05). However, after WAI at 14 Gy and 15 Gy, there were no significant differences in body weight and DAI between the FLASH group and the CONV group ( P>0.05). At 7 d after single-fraction WAI at 11, 12, and 13 Gy, mice in the FLASH group exhibited less intestinal congestion, edema, and shortening compared with the CONV group. The difference between the FLASH and CONV groups were statistically significant in small intestine length at 11 and 13 Gy ( t=4.42, 3.78, P<0.05), and in colorectal length at 11 and 12 Gy ( t=3.97, 3.12, P<0.05). Small intestine HE staining revealed superior preservation of intestinal architecture in the FLASH group compared with the CONV group, characterized by longer villi, increased crypt numbers, thicker mucosal epithelium, and enhanced structural integrity. The differences in crypt number and mucosal epithelial thickness were statistically significant ( tcrypt=13.10, 23.80, 11.90; tmucosal=5.75, 2.64, 7.74; P<0.05). At 15 d post-irradiation, the survival rate in the 15 Gy FLASH group was higher than that in the CONV group (50% vs. 10%, χ2=5.39, P<0.05), with a median survival extension of 6 d ( HR=0.340, 95% CI: 0.115 4-0.999 9). No significant survival differences were observed between the FLASH group and the CONV group at 11, 12, 13, and 14 Gy ( P>0.05). Conclusions:FLASH irradiation significantly alleviated acute radiation-induced intestinal injury from medium single-fraction WAI with 11, 12, and 13 Gy X-rays compared with CONV irradiation, and showed potential to improve mouse survival after single-fraction WAI at 15 Gy. This effect is likely associated with the preservation of intestinal crypts and exhibits a dose-dependent relationship.

Objective:To observe the longitudinal changes of symptoms in the irradiation area of patients with postoperative radiotherapy for breast cancer,and investigate the correlative symptom indexes for predicting acute radiation dermatitis during radiotherapy.Methods:This study was designed as a prospective longitudinal study.A total of 103 patients with breast cancer who received three-dimensional con-formal radiotherapy in The Fourth Hospital of Hebei Medical University from May 2022 to December 2022 were enrolled using convenience and purposive sampling methods.The patients received a total of 50 Gy/25 radiotherapy sessions.We conducted weekly observations of five symptoms-itching,pain,swelling,burning,and tightness-in the irradiated area,for a total of six weeks.The incidence of symptoms associ-ated with radiation dermatitis across different severity levels was compared.We calculated the optimal number of symptoms for the occur-rence of grade 2 or higher radiation dermatitis,evaluated the predictive effect using the subject's work characteristic curve(ROC),and com-pared the risk of radiation dermatitis with the number of symptoms by applying a binary Logistic regression.Results:A total of 103 patients were included in the study.The total severity scores of symptoms were 0(0,0),0(0,0),0(0,1),1(0,2),2(1,3),3(2,4),respectively,show-ing a gradually increasing trend.From the 20 Gy/10-fraction radiotherapy point onward to the completion of radiotherapy,symptom scores exhibited statistically significant deviations from baseline values(P<0.001).From the beginning of 30 Gy/15 sessions to the end of radiother-apy,symptom scores were higher in patients with grade 2 and above dermatitis compared to those with dermatitis of less than grade 2(Z=2.12,2.81,4.08,P=0.034,0.005,0.001);at the end of 50Gy/25 sessions,the incidence rates of pruritus,pain,swelling,tightness,and burning were 68.9%(71 cases),68.9%(71 cases),46.6%(48 cases),36.9%(38 cases),and 15.5%(16 cases),respectively.At the 30 Gy/15 and 40 Gy/20 radiotherapy sessions,the optimal number of predicted symptoms were two and three,respectively.The corresponding areas under the ROC curve were 0.632 and 0.666.Sensitivity values were 48.6%and 43.2%,while specificity values reached 77.3%and 81.8%,re-spectively(95%CI:0.517-0.746,0.558-0.775,P=0.027,0.005).The subjects were assigned into low-risk and high-risk groups using the op-timal cut-off values,and binary Logistic regression showed that the risks of grade 2 and higher radiation dermatitis in the high-risk group were 3.39 and 3.58 times higher than that in the low-risk group(OR=3.388,95%CI:1.400-8.197,P=0.007;OR=3.584,95%CI:1.430-8.985,P=0.006).Conclusions:The symptoms of radiation dermatitis have appeared early and worsened with the severity of dermatitis.We should closely observe these symptoms throughout treatment.The risk of grade 2 and above radiation dermatitis increased when the number of symptoms was≥2 at 30 Gy/15 times and≥3 at 40 Gy/20 times.

BACKGROUND:A large number of studies have found that pyroptosis is closely related to the occurrence and development of motor system diseases,but there are few studies and reviews on pyroptosis in motor system diseases.OBJECTIVE:To review the current clinical and preclinical studies,summarize the role of pyroptosis in motor system diseases and related molecular mechanisms,and provide reference for the pyroptosis-targeted treatment for motor system diseases in the future.METHODS:The relevant literatures in PubMed and CNKI database were searched by computer from January 2000 to January 2024.The English search terms were"pyroptosis,tendons,ligaments,cartilage,muscles,bones"and the Chinese search terms were"pyroptosis,tendon,ligament,cartilage,skeletal muscle,bone"in Chinese.A combination of subject terms and free search terms was used.There were a total of 422 documents,including 334 in English and 88 in Chinese.After excluding duplicate literature and irrelevant literature,the literature without inclusion value was further excluded by reading the whole paper,and finally 78 documents were included for review and analysis.RESULTS AND CONCLUSION:Different pathways of pyroptosis and subsequent inflammatory responses can affect the progression of motor system diseases and the repair process of injuries.Excessive pyroptosis can not only cause a large number of tissue cells to die,but also aggravate tissue inflammation and degrade the extracellular matrix through substances such as inflammatory factors released after cell lysis,and damaging related molecular patterns can act as upstream signals to further aggravate pyroptosis.Current methods for preventing and treating motor system diseases mainly include NOD-like receptor thermal protein domain-associated protein 3 inhibitors,Chinese herbal extracts,exosome therapy,mesenchymal stem cell therapy,and exercise therapy.The review suggests that targeted intervention of some key factors in the process of pyroptosis may be a new direction for the treatment and prevention of motor system diseases.

Objective:To observe the longitudinal changes of symptoms in the irradiation area of patients with postoperative radiotherapy for breast cancer,and investigate the correlative symptom indexes for predicting acute radiation dermatitis during radiotherapy.Methods:This study was designed as a prospective longitudinal study.A total of 103 patients with breast cancer who received three-dimensional con-formal radiotherapy in The Fourth Hospital of Hebei Medical University from May 2022 to December 2022 were enrolled using convenience and purposive sampling methods.The patients received a total of 50 Gy/25 radiotherapy sessions.We conducted weekly observations of five symptoms-itching,pain,swelling,burning,and tightness-in the irradiated area,for a total of six weeks.The incidence of symptoms associ-ated with radiation dermatitis across different severity levels was compared.We calculated the optimal number of symptoms for the occur-rence of grade 2 or higher radiation dermatitis,evaluated the predictive effect using the subject's work characteristic curve(ROC),and com-pared the risk of radiation dermatitis with the number of symptoms by applying a binary Logistic regression.Results:A total of 103 patients were included in the study.The total severity scores of symptoms were 0(0,0),0(0,0),0(0,1),1(0,2),2(1,3),3(2,4),respectively,show-ing a gradually increasing trend.From the 20 Gy/10-fraction radiotherapy point onward to the completion of radiotherapy,symptom scores exhibited statistically significant deviations from baseline values(P<0.001).From the beginning of 30 Gy/15 sessions to the end of radiother-apy,symptom scores were higher in patients with grade 2 and above dermatitis compared to those with dermatitis of less than grade 2(Z=2.12,2.81,4.08,P=0.034,0.005,0.001);at the end of 50Gy/25 sessions,the incidence rates of pruritus,pain,swelling,tightness,and burning were 68.9%(71 cases),68.9%(71 cases),46.6%(48 cases),36.9%(38 cases),and 15.5%(16 cases),respectively.At the 30 Gy/15 and 40 Gy/20 radiotherapy sessions,the optimal number of predicted symptoms were two and three,respectively.The corresponding areas under the ROC curve were 0.632 and 0.666.Sensitivity values were 48.6%and 43.2%,while specificity values reached 77.3%and 81.8%,re-spectively(95%CI:0.517-0.746,0.558-0.775,P=0.027,0.005).The subjects were assigned into low-risk and high-risk groups using the op-timal cut-off values,and binary Logistic regression showed that the risks of grade 2 and higher radiation dermatitis in the high-risk group were 3.39 and 3.58 times higher than that in the low-risk group(OR=3.388,95%CI:1.400-8.197,P=0.007;OR=3.584,95%CI:1.430-8.985,P=0.006).Conclusions:The symptoms of radiation dermatitis have appeared early and worsened with the severity of dermatitis.We should closely observe these symptoms throughout treatment.The risk of grade 2 and above radiation dermatitis increased when the number of symptoms was≥2 at 30 Gy/15 times and≥3 at 40 Gy/20 times.