Stroke is the leading cause of death and disability among adults in China， and its common complications include digestive system abnormalities， cognitive impairment， depression， stroke-associated pneumonia， and hemiplegia. The combination of traditional Chinese and Western medicine has great potential in treating post-stroke complications. Xinglou Chengqitang （XLCQT） is a representative prescription of alleviating the disease in the upper part by treating the lower part. It has definite therapeutic effect and high safety. Clinically， XLCQT is often used to treat stroke and its complications. However， the quantity and quality of clinical trials of XLCQT in treating post-stroke complications need to be improved. Additionally， since the basic research is weak， the material basis and multi-target mechanism for the efficacy of this prescription are unknown. This article reviews XLCQT in terms of the pharmacodynamic basis， medicinal properties， safety evaluation， and progress in clinical research and mechanisms in treating post-stroke complications. This article summarizes 22 key active ingredients of XLCQT in treating acute stroke complicated with syndrome of phlegm heat and fu-organ excess. Among these key active ingredients， resveratrol， kaempferol， luteolin， chrysoeriol， apigenin， （+）-catechin， and adenosine have good pharmacokinetic properties and high bioavailability. The mechanisms of XLCQT in treating post-stroke complications are complex， including inflammatory response， brain-gut axis， hypothalamic-pituitary-adrenal （HPA） axis， intestinal flora， neurotrophic factors， autophagy， oxidative stress， and free radical damage. This review helps to deeply understand the pharmacodynamic basis and mechanisms of XLCQT in treating post-stroke complications and provides a theoretical basis for the clinical application of XLCQT against post-stroke complications and the development of drugs.

Objective: To explore the associations of sedentary behavior and physical activity with next day affective states in junior and senior high school students, so as to provide a reference for promoting affective health in the population. Methods: From March to April 2026, 137 junior and senior high school students aged 12-17 years were recruited from two junior and senior high schools in Tianjin using convenience sampling. The ActiGraph wGT3X-BT accelerometer was used to continuously monitor 24 hour activity behaviors, and screen sedentary time (SST) and non-screen sedentary time were distinguished in combination with daily time use diaries. Daily affect levels in junior and senior high school students were collected via the Positive and Negative Affect Schedule-Expanded Form, with moods classified into high /low arousal positive affect and high /low arousal negative affect. Bayesian multilevel compositional data analysis and isotemporal substitution analysis were employed to explore the associations and substitution effects of sedentary behavior and 24 hour activity behaviors with next day affective states in junior and senior high school students. Results: Bayesian multilevel modeling showed that the associations between 24 hour movement behaviors and nextday affect in junior and senior high school students were mainly evident at the within person level. SST was associated with lower next day high arousal positive affect ( β =-0.15) and low arousal positive affect ( β = -0.11 ), and with higher high arousal negative affect ( β =0.12); light physical activity (LPA) was associated with higher high arousal positive affect ( β =0.13), and moderate to vigorous physical activity (MVPA) was associated with lower low arousal negative affect ( β =-0.06) (all P <0.05). Dose response analysis showed that, at the within person level, the substitution effect between SST and LPA was the most pronounced. As the duration of reallocating SST to LPA increased from 10 min to 60 min, high arousal positive affect ( β =0.020-0.123) and low arousal positive affect ( β =0.010-0.061) showed upward trends, while high arousal negative affect ( β =-0.061 to -0.010) showed a downward trend (all P <0.05); although low arousal negative affect presented a decreasing trend, it did not reach statistical significance at any time point ( β =-0.041 to -0.007, all P >0.05). Among the other substitution relationships, reallocating SST to MVPA was accompanied by a decrease in low arousal negative affect ( β =-0.033 to -0.005 ), and reallocating SST to sleep was accompanied by a decrease in high arousal negative affect ( β =-0.029 to -0.005) (all P < 0.05). Conclusions The associations between 24 hour activity behaviors and next day affect in junior and senior high school students are mainly evident at the within person level. Reallocating an individual s daily SST to LPA or MVPA can improve next day affective states in junior and senior high school students.

Mesangial cell proliferation is an early pathological indicator of diabetic nephropathy (DN). Growing evidence highlights the pivotal role of paired-related homeobox 1 (Prrx1), a key regulator of cellular proliferation and tissue differentiation, in various disease pathogenesis. Notably, Prrx1 is highly expressed in mesangial cells under DN conditions. Both in vitro and in vivo studies have demonstrated that Prrx1 overexpression promotes mesangial cell proliferation and contributes to renal fibrosis in db/m mice. Conversely, Prrx1 knockdown markedly suppresses hyperglycemia-induced mesangial cell proliferation and mitigates renal fibrosis in db/db mice. Mechanistically, Prrx1 directly interacts with the Yes-associated protein 1 (YAP) promoter, leading to the upregulation of YAP expression. This upregulation promotes mesangial cell proliferation and exacerbates renal fibrosis. These findings emphasize the crucial role of Prrx1 upregulation in high glucose-induced mesangial cell proliferation, ultimately leading to renal fibrosis in DN. Therefore, targeting Prrx1 to downregulate its expression presents a promising therapeutic strategy for treating renal fibrosis associated with DN.

Objective:To investigate the impact of delivery orders on the short-term clinical outcomes of preterm twins born before 32 weeks of gestation.Methods:A retrospective analysis was conducted on the clinical data of preterm twins born before 32 weeks of gestation who were admitted to the Neonatology Department of Women and Children's Hospital of Chongqing Medical University from January 2018 to December 2022. The twins were divided into two groups based on the order of delivery: the first-born group and the second-born group. The study analyzed the impact of delivery orders on resuscitation support measures and outcomes during the transition period in the delivery room, respiratory support modes and treatments in the neonatal intensive care unit (NICU), severe complications (hemodynamically significant patent ductus arteriosus, neonatal necrotizing entercolitis≥stage Ⅱ, early- and late-onset sepsis, retinopathy of prematurity, and intracranial hemorrhage), and mortality. Subgroup analyses were also conducted based on chorionicity and mode of delivery. Statistical analyses were performed using paired t-tests, rank-sum tests, and McNemar's tests (paired Chi-square tests). Results:(1) A total of 296 cases (148 pairs) of preterm twins born before 32 weeks of gestation were included in the study. The proportion of 1-minute Apgar scores≤7 was higher in the second-born group compared to the first-born group [27.7% (41/148) vs. 17.6% (26/148), χ2=5.94, P=0.015]; however, there were no statistically significant differences between the two groups in terms of the proportion of umbilical artery blood gas pH<7.2, 5-minute Apgar scores, intubation, use of pulmonary surfactant (PS) in the delivery room, chest compressions, birth weight, and/or adrenaline use. There were also no statistically significant differences in 1-minute Apgar scores≤7 between the first-born and second-born groups when analyzed by chorionicity and mode of delivery. (2) There was no statistically significant difference in the overall incidence of neonatal respiratory distress syndrome (NRDS) between the first-born and second-born groups, but the incidence of NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group [27.0% (40/148) vs. 16.9% (25/148), χ2=5.94, P=0.015]. There were no statistically significant differences between the two groups in terms of the proportion of single and multiple doses of PS use, the proportion and total duration of mechanical ventilation, and the incidence of bronchopulmonary dysplasia. Among dichorionic twins, the incidence of respiratory failure and NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group [87.4% (104/119) vs. 79.8% (95/119), paired Chi-square test, P=0.035; 27.7% (33/119) vs. 17.6% (21/119), χ2=4.03, P=0.045]. The incidence of NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group during vaginal delivery and cesarean section [51.6% (16/31) vs. 22.6% (7/31), paired Chi-square test, P=0.012; 20.5% (24/117) vs. 15.4% (18/117), χ2=56.14, P<0.001]. (3) There were no statistically significant differences in the mortality and the incidence of complications between the first-born and second-born groups. When analyzed by different chorionicity and delivery methods, the differences in the mortality and incidence of the complications between the different birth order groups were also not statistically significant. Conclusions:Among preterm twins born before 32 weeks of gestation, the proportion of second-born infants with a 1-minute Apgar score≤7 and the incidence of NRDS stages Ⅲ-Ⅳ were higher. However, with active resuscitation, management during the transition period in the delivery room, and respiratory support treatment, the birth order did not significantly affect the short-term incidence of severe complications and mortality in the second-born infants.

Objective:To investigate the effect of quality improvement (QI) project on delayed cord clamping (DCC) implementation in very preterm infants.Methods:This study retrospectively collected the clinical data and assessed the QI indices of very preterm infants born in the Women and Children's Hospital of Chongqing Medical University and transferred to the Neonatology Department from January 2017 to January 2021. The indices for QI assessment included three types: (1) process indices: the implementation rate and timing of DCC; (2) outcome indices: hemoglobin level and hematocrit, etc; (3) balancing indices: the proportion of neonates requiring endotracheal intubation in the delivery room and chest compressions, Apgar score body temperature, and blood pH value on admission, etc. There were four phases for the implementation of QI, the pre-QI period (January to December of 2017), the QI period (January to December of 2018), the post-QI period (January to December of 2019), and the sustained-QI period (January 2020 to January 2021). The QI project was performed since August 2018. Control charts or statistical tests were used for statistical analysis.Results:(1) Process indices: After the implementation of the QI project, the practice of DCC increased from 0 to 82.2%, and the timing of umbilical cord clamping was from 0 s to a delay of 47.1 s. (2) Outcome indices: The levels of hemoglobin in the QI period, the post-QI period, and the sustained-QI period were significantly higher than those in the pre-QI period [(202.22±28.84), (210.10±33.52), (210.52±32.27) g/L vs. (187.94±35.29) g/L; F=8.61, P<0.001]. The hematocrit values in the post-QI period and the sustained-QI period were significantly higher than those in the pre-QI period [(58.99±8.71) %, (60.18±8.06)% vs. (55.41±9.17)%; χ2=5.13, P=0.002]. The other indices showed no statistical differences in different phases. (3) Balancing indices: The proportions of neonates receiving endotracheal intubation in the delivery room in the post-QI period and the sustained-QI period were significantly lower than those in the pre-QI period [16.0% (19/119), 13.2% (25/191) vs. 42.3% (30/71); χ2=29.08, P<0.001]. The body temperature on admission increased gradually through the four periods [pre-QI period: 35.3 ℃ (34.5-36.1 ℃); QI period: 36.0 ℃ (34.0-37.7 ℃); post-QI period: 36.0 ℃ (35.6-37.4 ℃); sustained-QI period: 37.0 ℃ (35.9-38.1 ℃); H=277.88, P<0.001]. The blood pH value on admission in the sustained-QI period [7.32 (6.85-7.50)] was significantly higher than those in the other three periods [7.26 (7.07-7.46), 7.26 (7.04-7.43), and 7.25 (6.91-7.49); H=34.46, P<0.001]. Conclusion:The interventions in this QI project significantly increase the practice of DCC and enable a longer DCC in very preterm infants.

Objective:To investigate the impact of delivery orders on the short-term clinical outcomes of preterm twins born before 32 weeks of gestation.Methods:A retrospective analysis was conducted on the clinical data of preterm twins born before 32 weeks of gestation who were admitted to the Neonatology Department of Women and Children's Hospital of Chongqing Medical University from January 2018 to December 2022. The twins were divided into two groups based on the order of delivery: the first-born group and the second-born group. The study analyzed the impact of delivery orders on resuscitation support measures and outcomes during the transition period in the delivery room, respiratory support modes and treatments in the neonatal intensive care unit (NICU), severe complications (hemodynamically significant patent ductus arteriosus, neonatal necrotizing entercolitis≥stage Ⅱ, early- and late-onset sepsis, retinopathy of prematurity, and intracranial hemorrhage), and mortality. Subgroup analyses were also conducted based on chorionicity and mode of delivery. Statistical analyses were performed using paired t-tests, rank-sum tests, and McNemar's tests (paired Chi-square tests). Results:(1) A total of 296 cases (148 pairs) of preterm twins born before 32 weeks of gestation were included in the study. The proportion of 1-minute Apgar scores≤7 was higher in the second-born group compared to the first-born group [27.7% (41/148) vs. 17.6% (26/148), χ2=5.94, P=0.015]; however, there were no statistically significant differences between the two groups in terms of the proportion of umbilical artery blood gas pH<7.2, 5-minute Apgar scores, intubation, use of pulmonary surfactant (PS) in the delivery room, chest compressions, birth weight, and/or adrenaline use. There were also no statistically significant differences in 1-minute Apgar scores≤7 between the first-born and second-born groups when analyzed by chorionicity and mode of delivery. (2) There was no statistically significant difference in the overall incidence of neonatal respiratory distress syndrome (NRDS) between the first-born and second-born groups, but the incidence of NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group [27.0% (40/148) vs. 16.9% (25/148), χ2=5.94, P=0.015]. There were no statistically significant differences between the two groups in terms of the proportion of single and multiple doses of PS use, the proportion and total duration of mechanical ventilation, and the incidence of bronchopulmonary dysplasia. Among dichorionic twins, the incidence of respiratory failure and NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group [87.4% (104/119) vs. 79.8% (95/119), paired Chi-square test, P=0.035; 27.7% (33/119) vs. 17.6% (21/119), χ2=4.03, P=0.045]. The incidence of NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group during vaginal delivery and cesarean section [51.6% (16/31) vs. 22.6% (7/31), paired Chi-square test, P=0.012; 20.5% (24/117) vs. 15.4% (18/117), χ2=56.14, P<0.001]. (3) There were no statistically significant differences in the mortality and the incidence of complications between the first-born and second-born groups. When analyzed by different chorionicity and delivery methods, the differences in the mortality and incidence of the complications between the different birth order groups were also not statistically significant. Conclusions:Among preterm twins born before 32 weeks of gestation, the proportion of second-born infants with a 1-minute Apgar score≤7 and the incidence of NRDS stages Ⅲ-Ⅳ were higher. However, with active resuscitation, management during the transition period in the delivery room, and respiratory support treatment, the birth order did not significantly affect the short-term incidence of severe complications and mortality in the second-born infants.

Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.

Objective: An isochronous substitution model was established to explore the association and substitution effect between college students 24 hour activity behavior and physical health, so as to provide specific activity behavior suggestions for college students to improve their physical health. Methods: A stratified random cluster sampling method was used to conduct physical fitness tests and 24 hour activity behavior surveys among 2 794 college students in 12 colleges and universities in Tianjin.Time spent on sedentary behavior(SB), light intensity physical activity(LPA), moderate to vigorous physical activity(MVPA) and sleep(SLP) time. The isochronous method of components was used to explore the relationship between 24 h activity behavior and physical health. Results: Except for 50 m running, MVPA was negatively correlated with BMI Z ( β =-0.62, P <0.05), but positively correlated with other physical fitness indexes ( β =0.34~274.23, P <0.05). LPA was not associated with lung capacity, sitting forward flexion and 50 m running, and negatively correlated with other physical fitness indexes ( β =-14.30- -0.19, P <0.05). SB was negatively correlated with most physical fitness indexes ( β =-11.57- -0.33, P <0.05), but positively correlated with BMI Z ( β =0.45, P < 0.05 ). In addition to lung capacity, SLP was positively correlated with BMI Z , total physical fitness score,1 minute sit-ups, pull ups, 800/1 000 m running, sitting forward flexion, and 50 m running ( β =0.27-11.21, P <0.05), but negatively correlated with long jump ( β =-0.10, P <0.05）. Isochronous substitution showed that the adverse effects of 30 min/d SB and LPA substitution of MVPA were much greater than the beneficial effects of MVPA substitution for corresponding behaviors (total physical score: SB, -0.58 vs 0.47 points; LPA, -0.50 vs 0.38 points). Conclusion MVPA and SLP have been found to have a positive effect on physical fitness among college students. Therefore, in the process of improving the physical health of college students, ensuring adequate sleep, improving MVPA and reducing SB as much as possible may be one of the effective methods.

Objective To analyze the influence of different health-related indicators on the prognosis of elderly patients with diabetes mellitus complicated with coronary heart disease, and to provide theoretical basis for the diagnosis and treatment of diabetes mellitus complicated with coronary heart disease. Methods Among of 456 elderly patients with diabetes mellitus complicated with coronary heart disease admitted to our hospital from December 2018 to December 2020 were selected. According to the occurrence of Major adverse cardiovascular events (MACE) within 1 year after discharge, patients were divided into the control group (no MACE) and the observation group (MACE). The Clinical data of patients including age, gender, BMI, smoking, alcohol consumption, diabetes course, degree of coronary artery stenosis and number of lesions, were collected from the medical record system. Univariate analysis and logistic regression were used to analyze the influence of health indicators such as systolic blood pressure, LEVF, HbA1c, LDL-C, LDH and ALP on the occurrence of MACE in patients with diabetes and coronary heart disease. Spearman correlation analysis was used to analyze the correlation between different health-related indicators and the occurrence of MACE in elderly patients with diabetes mellitus and coronary heart disease. Results A total of 456 elderly patients with diabetes mellitus and coronary heart disease, 122 cases (26.75%) developed MACE. There were no differences in age, male proportion, BMI, smoking and drinking of diabetes course between the two groups (P>0.05). The degree and number of coronary artery stenosis in the observation group were significantly higher than those in the control group (P<0.05). There were significant differences in HbA1c, LEVF, LDL-C, TC, TG and BUA between the two groups (P<0.05). HbA1c>7.0% (OR=2.617), LDL-C>2.6 mmol/L (OR=2.976) and BUA >420μmol/L (OR=2.341) were independent risk factors for MACE in elderly patients with diabetes mellitus and coronary heart disease (P<0.05). Spearman correlation analysis showed that HbA1c, LDL-C, BUA were positively correlated with MACE in elderly patients with diabetes mellitus and coronary heart disease (r=0.401,0.427,0.372, P<0.05). Conclusion Elderly patients with diabetes mellitus complicated with coronary heart disease have a higher risk of MACE, which is closely related to health-related indicators. For patients with HbA1c >7.0%, LDL-C >2.6 mmol/L and BUA >420 μmol/L, active treatment should be conducted to improve the prognosis of patients.

Objective: To explore the relationship between isochronous substitution and BMI, waist circumference (WC), and body fat rate (FAT) among physical activity (PA), sedentary (SB), and sleep (SLP), so as to provide effective measures for obesity control in adolescents. Methods: A total of 193 adolescents aged 12-15 (90 males and 103 females) was randomly selected, and their height, weight, and BMI were measured using routine testing methods from May to August 2022. The PA, SB and SLP of the participants were measured using a 3D accelerometer (ActiGraph GT3X+). Results: The arithmetic mean value overestimated SLP (40.8%) and SB (39.6%) to some extent, and underestimated LPA (16.1%) and MVPA (3.5%) to some extent. Based on the ISM at 15 min, MVPA was substituted for other activity, BMI Z decreased by 0.17-0.22 units, WC Z decreased by 0.16-0.20 units, and FAT Z decreased by 0.17-0.22 units. The substitution between MVPA and for other activity exhibited significant asymmetry. The effects of MVPA substitutions for SB was the largest, followed by the effects of MVPA substitutions for SLP, and the effects of MVPA substitutions for LPA was the lowest. As MVPA substitutions for other behaviors, it reached its maximum (0.06-0.08 units ) when the MVPA time increased by 5 minutes. Conclusions MVPA plays an irreplaceable role in the control of adolescent obesity . While reducing SB time, MVPA duration should be increased to ensure that the daily MVPA duration is not less than 55 minutes in order to effectively control obesity.