Objective:To investigate the staging of cardiovascular-kidney-metabolic (CKM) syndrome before onset, and to analyze its impact on short-term prognosis in patients with acute myocardial infarction (AMI).Methods:The clinical data of 2 993 patients with AMI from January 2017 to December 2023 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The basic information, baseline data, in-hospital data, cardiac-related examination results, CKM syndrome staging and in-hospital outcomes were recorded.Results:Among the 2 993 patients with AMI, the CKM syndrome stage 0 was in 23 cases (0.77%), stage 1 in 35 cases (1.17%), stage 2 in 2 015 cases (67.32%), stage 3 to 4 in 920 cases (30.74%). The male proportion, high density lipoprotein-cholesterol (HDL-C) and neutrophil-to-lymphocyte ratio in patients with CKM syndrome stage 0 and 1 were significantly higher than those in patients with CKM syndrome stage 2 and 3 to 4, the hypertension proportion, diabetes proportion, chronic kidney disease proportion, triglyceride (TG), glycated hemoglobin (HbA 1c) and creatinine were significantly lower than those in patients with CKM syndrome 2 stage 3 to 4, and there were statistical differences ( P<0.05); the body mass index (BMI) and non-ST-elevation myocardial infarction (NSTEMI) proportion in patients with CKM syndrome stage 0 were significantly lower than those in patients with CKM syndrome stage 1, 2 and 3 to 4, and there were statistical differences ( P<0.05); the cerebrovascular diseases proportion, Killip stage ≥3 proportion, N-terminal pro-brain natriuretic peptide (NT-proBNP) and left main coronary artery lesions proportion in patients with CKM syndrome stage 0, 1 and 2 were significantly lower than those in patients with CKM syndrome stage 3 to 4, and there were statistical differences ( P<0.05); the global registry of acute coronary events score (GRACE score) in patients with CKM syndrome stage 0 was significantly lower than that in patients with CKM syndrome stage 3 to 4, and there was statistical difference ( P<0.05). Although there were statistical differences in low density lipoprotein-cholesterol (LDL-C) and number of blood vessels involved among the four groups ( P<0.05), but pairwise comparisons showed no statistically significant differences ( P>0.05). There were no statistical differences in age, smoking history, hyperlipidemia, high-sensitivity C-reactive protein, uric acid, cardiac troponin I (cTnI) peak, left ventricular ejection fraction and left ventricular end-diastolic diameter among the four groups ( P>0.05). The incidence of in-hospital major adverse coronary events (MACE) was 10.76% (322/2 993). Among them, the incidence of MACE, all-cause mortality and longer length of stay in patients with CKM syndrome stage 0, 1 and 2 were significantly lower than those in patients with CKM syndrome stage 3 to 4: 4.35% (1/23), 8.57% (3/35) and 8.59% (173/2 015) vs. 15.76% (145/920), 0, 2.86% (1/35) and 2.38% (48/2 015) vs. 4.78% (44/920), (8.17 ± 3.87), (8.15 ± 5.32) and (8.89 ± 6.42) d vs. (9.81 ± 9.29) d, and there were statistical differences ( P<0.05); the incidences of acute kidney injury and atrial fibrillation in patients with CKM syndrome stage 0 and 1 were significantly lower than those in patients with CKM syndrome stage 2 and 3 to 4: 8.70% (2/23) and 8.57% (3/35) vs. 24.17% (487/2 015) and 34.35% (316/920), 0 and 0 vs. 3.52% (71/2 015) and 10.00% (92/920), and there were statistical differences ( P<0.05); there were no statistical differences in the incidences of ventricular tachycardia/ventricular fibrillation, cardiac arrest, mechanical complications and mechanical circulatory support among the four groups ( P>0.05). Conclusions:The severity of CKM syndrome is closely related to the occurrence of AMI. CKM patients with higher CKM stages have more severe AMI and poorer in-hospital prognosis. CKM syndrome staging can serve as a potential prognostic indicator for AMI patients.

Objective:To develop a prediction model for the dosage of antivenom in patients envenomed by Trimeresurus stejnegeri (bamboo pit viper) using Lasso-Logistic regression.Methods:A retrospective cohort study was conducted including 165 patients with Trimeresurus stejnegeri bites admitted to the Emergency General Ward of Yangjiang Hospital Affiliated to Guangdong Medical University (Yangjiang People's Hospital) between October 31, 2021, and November 1, 2024. Data on demographic characteristics, key clinical signs, laboratory parameters, antivenom treatment regimen, and total antivenom dosage were collected. Predictive variables were selected using LASSO and Logistic regression methods. The prediction model was constructed using R software. Model calibration was assessed using the Hosmer-Lemeshow test, discriminative ability via the receiver operating characteristic (ROC) curve, and clinical utility using decision curve analysis.Results:Among the 165 enrolled patients, 71 received a total antivenom dose of ≤3 vials, and 94 received >3 vials. Six predictors for requiring >3 vials of antivenom were identified: pain severity, swelling degree, serum treatment regimen, 3P-test result, white blood cell count (WBC), and fibrinogen level (FIB). After comparing 22 prediction models incorporating 4 to 6 variables, the model comprising swelling degree, pain severity, WBC, and FIB was selected. The calibration curve indicated good agreement between predicted and actual risks. The area under the ROC curve (AUC) was 0.78 (95% CI: 0.71–0.85), demonstrating satisfactory discriminative ability for predicting whether the total antivenom dose exceeded 3 vials. Conclusions:The risk prediction model shows good performance in identifying whether the total antivenom dose exceeds 3 vials in Trimeresurus stejnegeri bite patients. It incorporates six readily available clinical variables: pain severity, swelling degree, serum regimen, 3P-test, WBC, and FIB. A model based on pain severity, swelling degree, WBC, and FIB can assist clinicians in predicting whether a patient will require more than 3 vials of antivenom after standard treatment.

[Objective]To explore the pattern of analogical pharmacology and efficacy of"Chinese medicines from covering",which refers to the barks of plants,skins of animals and peels of fruits used as medicines to treat diseases.[Methods]Based on the principle of analogical pharmacology and on the basis of the principle that"Chinese medicines from covering affecting the skin",this paper combines the records in herbal medical classics and clinical medication experience to further analyze the efficacy characteristics of Chinese medicines from covering and summarize the efficacy characteristics of subdivided categories such as fruit peels,bark of trunks,root barks and animal skins.[Results]Chinese medicines from covering have the characteristics of functioning well at entering the lung and large intestine and exerting the effects of relieving cough and diarrhea.This is particularly true for medicines made from fruit peels,such as Pyrus bretschneideri Rehd.peel,Trichosanthes kirilowii Maxim.peel,Exocarpium Citri Grandis and Papaver somniferum L.pericarp.In addition,Morus alba L.root-bark,Fraxinus rhynchophylla Hance bark,Erinaceus europaeus L.skin and Ailanthus altissima(Mill.)Swingle bark also have a preference for entering the lung and large intestine meridians.Chinese medicines from covering have the efficacy characteristic of adepting at nourishing Yin,such as Colla Corii Asini(E jiao),pig skin and Bos taurus domesticus Gmelin hide gelatin,etc.This kind of Chinese medicines from covering generally comes from animal skins.Chinese medicines from covering like Citrus reticulata Blanco pericarp,Pericarpium Citri Reticulatae Viride,Poncirus trifoliata(L.)Raf.fruit,Areca catechu L.peel and Magnolia officinalis Rehd.et Wils.bark are rich in volatile oils and good at regulating Qi and relieving distension.Chinese medicines from covering have the characteristics of being good at entering the lower-Jiao,tonifying the liver and kidney,strengthening the muscles and bones,and consolidating kidney Qi,This is especially true for medicines made from trunk and root barks,such as Phellodendron chinense Schneid.bark,Paeonia suffruticosa Andr.root-bark,Lycium chinense Mill.root-bark,Eleutherococcus gracilistylus W.W.Smith bark and Cinnamomum cassia Presl bark.[Conclusion]In addition to"affecting the skin",Chinese medicines from covering possess various characteristics of efficacy patterns.In the theory of the Five Elements,Chinese medicines from covering pertain to metal.The characteristics of metal Qi,such as its high-rising nature,its functions of ripening,descending and its dryness,are the root causes of the efficacy characteristics of Chinese medicines from covering.These include acting on the skin and the exterior,entering the lungs and large intestine,being rich in colloids and oils,being good at tonifying the liver and kidney,and clearing heat and drying dampness.

Objective:To investigate the staging of cardiovascular-kidney-metabolic (CKM) syndrome before onset, and to analyze its impact on short-term prognosis in patients with acute myocardial infarction (AMI).Methods:The clinical data of 2 993 patients with AMI from January 2017 to December 2023 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The basic information, baseline data, in-hospital data, cardiac-related examination results, CKM syndrome staging and in-hospital outcomes were recorded.Results:Among the 2 993 patients with AMI, the CKM syndrome stage 0 was in 23 cases (0.77%), stage 1 in 35 cases (1.17%), stage 2 in 2 015 cases (67.32%), stage 3 to 4 in 920 cases (30.74%). The male proportion, high density lipoprotein-cholesterol (HDL-C) and neutrophil-to-lymphocyte ratio in patients with CKM syndrome stage 0 and 1 were significantly higher than those in patients with CKM syndrome stage 2 and 3 to 4, the hypertension proportion, diabetes proportion, chronic kidney disease proportion, triglyceride (TG), glycated hemoglobin (HbA 1c) and creatinine were significantly lower than those in patients with CKM syndrome 2 stage 3 to 4, and there were statistical differences ( P<0.05); the body mass index (BMI) and non-ST-elevation myocardial infarction (NSTEMI) proportion in patients with CKM syndrome stage 0 were significantly lower than those in patients with CKM syndrome stage 1, 2 and 3 to 4, and there were statistical differences ( P<0.05); the cerebrovascular diseases proportion, Killip stage ≥3 proportion, N-terminal pro-brain natriuretic peptide (NT-proBNP) and left main coronary artery lesions proportion in patients with CKM syndrome stage 0, 1 and 2 were significantly lower than those in patients with CKM syndrome stage 3 to 4, and there were statistical differences ( P<0.05); the global registry of acute coronary events score (GRACE score) in patients with CKM syndrome stage 0 was significantly lower than that in patients with CKM syndrome stage 3 to 4, and there was statistical difference ( P<0.05). Although there were statistical differences in low density lipoprotein-cholesterol (LDL-C) and number of blood vessels involved among the four groups ( P<0.05), but pairwise comparisons showed no statistically significant differences ( P>0.05). There were no statistical differences in age, smoking history, hyperlipidemia, high-sensitivity C-reactive protein, uric acid, cardiac troponin I (cTnI) peak, left ventricular ejection fraction and left ventricular end-diastolic diameter among the four groups ( P>0.05). The incidence of in-hospital major adverse coronary events (MACE) was 10.76% (322/2 993). Among them, the incidence of MACE, all-cause mortality and longer length of stay in patients with CKM syndrome stage 0, 1 and 2 were significantly lower than those in patients with CKM syndrome stage 3 to 4: 4.35% (1/23), 8.57% (3/35) and 8.59% (173/2 015) vs. 15.76% (145/920), 0, 2.86% (1/35) and 2.38% (48/2 015) vs. 4.78% (44/920), (8.17 ± 3.87), (8.15 ± 5.32) and (8.89 ± 6.42) d vs. (9.81 ± 9.29) d, and there were statistical differences ( P<0.05); the incidences of acute kidney injury and atrial fibrillation in patients with CKM syndrome stage 0 and 1 were significantly lower than those in patients with CKM syndrome stage 2 and 3 to 4: 8.70% (2/23) and 8.57% (3/35) vs. 24.17% (487/2 015) and 34.35% (316/920), 0 and 0 vs. 3.52% (71/2 015) and 10.00% (92/920), and there were statistical differences ( P<0.05); there were no statistical differences in the incidences of ventricular tachycardia/ventricular fibrillation, cardiac arrest, mechanical complications and mechanical circulatory support among the four groups ( P>0.05). Conclusions:The severity of CKM syndrome is closely related to the occurrence of AMI. CKM patients with higher CKM stages have more severe AMI and poorer in-hospital prognosis. CKM syndrome staging can serve as a potential prognostic indicator for AMI patients.

[Objective]To explore the pattern of analogical pharmacology and efficacy of"Chinese medicines from covering",which refers to the barks of plants,skins of animals and peels of fruits used as medicines to treat diseases.[Methods]Based on the principle of analogical pharmacology and on the basis of the principle that"Chinese medicines from covering affecting the skin",this paper combines the records in herbal medical classics and clinical medication experience to further analyze the efficacy characteristics of Chinese medicines from covering and summarize the efficacy characteristics of subdivided categories such as fruit peels,bark of trunks,root barks and animal skins.[Results]Chinese medicines from covering have the characteristics of functioning well at entering the lung and large intestine and exerting the effects of relieving cough and diarrhea.This is particularly true for medicines made from fruit peels,such as Pyrus bretschneideri Rehd.peel,Trichosanthes kirilowii Maxim.peel,Exocarpium Citri Grandis and Papaver somniferum L.pericarp.In addition,Morus alba L.root-bark,Fraxinus rhynchophylla Hance bark,Erinaceus europaeus L.skin and Ailanthus altissima(Mill.)Swingle bark also have a preference for entering the lung and large intestine meridians.Chinese medicines from covering have the efficacy characteristic of adepting at nourishing Yin,such as Colla Corii Asini(E jiao),pig skin and Bos taurus domesticus Gmelin hide gelatin,etc.This kind of Chinese medicines from covering generally comes from animal skins.Chinese medicines from covering like Citrus reticulata Blanco pericarp,Pericarpium Citri Reticulatae Viride,Poncirus trifoliata(L.)Raf.fruit,Areca catechu L.peel and Magnolia officinalis Rehd.et Wils.bark are rich in volatile oils and good at regulating Qi and relieving distension.Chinese medicines from covering have the characteristics of being good at entering the lower-Jiao,tonifying the liver and kidney,strengthening the muscles and bones,and consolidating kidney Qi,This is especially true for medicines made from trunk and root barks,such as Phellodendron chinense Schneid.bark,Paeonia suffruticosa Andr.root-bark,Lycium chinense Mill.root-bark,Eleutherococcus gracilistylus W.W.Smith bark and Cinnamomum cassia Presl bark.[Conclusion]In addition to"affecting the skin",Chinese medicines from covering possess various characteristics of efficacy patterns.In the theory of the Five Elements,Chinese medicines from covering pertain to metal.The characteristics of metal Qi,such as its high-rising nature,its functions of ripening,descending and its dryness,are the root causes of the efficacy characteristics of Chinese medicines from covering.These include acting on the skin and the exterior,entering the lungs and large intestine,being rich in colloids and oils,being good at tonifying the liver and kidney,and clearing heat and drying dampness.

Children with certain comorbidities and immunocompromising conditions are highly vulnerable to SARS-CoV-2 infection. Vaccination against SARS-CoV-2 is an important strategy to reduce death， critical illness and overall disease burden. With the evolving and increasing transmission of SARS-CoV-2， universal vaccination is essential to achieve this goal. Children with special medical conditions are considered as the priorities for SARS-CoV-2 vaccination. However， vaccine hesitancy towards the implementation of SARS-CoV-2 vaccination currently remains an urgent challenge. In order to promote the sustainable vaccination for those children in Shanghai as well as China， Shanghai municipal center for disease control and prevention， together with the national children’s medical center， children’s hospital of Fudan university and the expert group on immunization planning of the Shanghai preventive medicine association， organized a consensus expert working group to formulate the evidence-based recommendations and implementation suggestions for children with common chronic diseases， allergy history， diseases involving adverse events related to vaccination， and immunocompromising conditions， based on the published evidence of SARS-CoV-2 vaccination for populations and children with special medical conditions.

Objective:To analyze the social family factors influencing language delay in children with the age ranging from 18 to 42 months in Xiamen.Methods:A prospective cohort study was conducted to evaluate children with language delay (case group) and normal controls (control group) in Child Health Clinic and Developmental Behavior Clinic of the First Affiliated Hospital of Xiamen University between July 2017 and July 2019 via a self-made questionnaire and a language development scale, and the case-control ratio was 1∶4.The chi- square test, Logistic regression and generalized multifactor dimensionality reduction (GMDR) were adopted for statistical analysis, and the correction analysis was performed with Bonferroni correction. Results:A total of 126 children with language delay were collected in the case group, with the ratio of male to female being 2.05∶1.00. The control group was included 504 cases.There was no significant difference in gender and age between both groups.The chi- square test showed that there were statistical differences in maternal culture and screen time distribution between both groups ( P<0.05/13). Besides, the multivariate Logistic regression analysis suggested that significant risk factors for language delay in children included maternal culture, maternal-child interaction, and screen time.The GMDR analysis showed that screen time was the optimal single-mode for children at risk of language delay, while maternal culture and screen time constituted a statistically different two-factor model.Moreover, the marital-child interaction was included into the three-factor model. Conclusions:Screen time and maternal culture were the most important risk factors for language delay in children of Xiamen, and both factors would interact with maternal-child interaction, which could exert impacts on language delay in children.

Objective To evaluate the clinical value of 3D reconstruction in the single utility-port thoracoscopic segmentectomy of early stage NSCLC by propensity score matching (PSM). Methods We retrospectively analyzed clinical data of 150 early stage NSCLC patients undergoing single utility-port thoracoscopic segmentectomy. The patients were divided into reconstruction group (n=58) and non-reconstruction group (n=92) according to 3D reconstruction. PSM was performed on two groups to compare perioperative outcomes. Results Procedures were successfully completed on all patients, without perioperative death. In each group, 43 patients were successfully matched after PSM on the basis of 8 confounding factors, age, gender, smoking status, BMI, maximum tumor diameter on CT, tumor location, % FEV1 and type of planned segmentectomy. After PSM, in complex segmentectomy, the patients in the reconstruction group had shorter operation time (155.77±30.17 vs. 212.94±66.49min, P < 0.001) and less blood loss (46.00±25.94 vs. 88.79±68.36ml, P=0.002), compared with the non- reconstruction group. Conclusion Preoperative 3D reconstruction could help improve the efficiency of single utility-port thoracoscopic surgery for complex segmentectomy and reduce intraoperative bleeding.

Objective:To compare the pharmacoeconomics value of domestic olanzapine with imported olanzapine in the treatment of schizophrenia to provide reference for the rational drug use in clinics. Methods:Two hundred patients with schizophrenia were ran-domly divided into group A ( treated with domestic olanzapine ) and group B ( treated with imported olanzapine ) with 100 cases in each. The treatment course was 8 weeks. The patient’ s condition, adverse reactions, social function, quality of life and daily activity in the two groups were evaluated. Meanwhile, cost-efficacy analysis was performed. Results:The scores of PANSS, SDSS, SQLS and ADL after the treatment were all significantly lower than those before the treatment in both groups (P<0. 01). However, there was no significant difference between the two groups (P>0. 05). In the 2nd and 4th weekend after the treatment, the scores of TESS in group A were all significantly higher than those in group B (P<0. 01). The effectiveness of the two groups was similar. The cost in group A was significantly lower than that in group B(P<0. 01). The efficacy-cost ratio in group A was higher than that in group B(P<0. 01). Conclusion:The domestic olanzapine is as effective and safe as imported olanzapine in the treatment of schizophrenia with lower treat-ment cost. Therefore, the pharmacoeconomics value of domestic olanzapine is much better.

Objective To compare the influence of different admission modes on quality of life of patients with chronic schizophrenia.Methods 200 patients with chronic schizophrenia were randomly assigned to discontinuous group and continuous group with 100 cases in each group. All patients were treated with atypical antipsychotic drugs. A discontinuous hospitalization combined with home treatment was given to the discontinuous group and a continuous hospitalization to the continuous group for 1 year. The Positive and Negative Syndrome Scale (PANSS) and the Schizophrenia Quality of Life Scale (SQLS) were respectively used to evaluate the patient's condition and quality of life before and after the intervention. Results The intervention methods on scores of PANSS and SQLS in both groups had a change trend with time. The scores of PANSS and SQLS were significantly lower in the end of 6 months and 1 year after intervention than before in both groups (F=2119.513, 390.981, P=0.000). There was a interaction effect between intervention method and time in both groups on the scores of PANSS and SQLS (F=17.660, 11.709, P=0.000). There was significant difference between 2 groups on the score of PANSS (F=19.673,P=0.000). The decrease range of those scores was greater in the discontinuous group than in the continuous group (P=0.000). Conclusion A discontinuous hospitalization combined with home treatment is more beneficial than a continuous hospitalization for the patients with chronic schizophrenia in controlling the syndrome and improving or keeping the quality of life.