The prescription of Qidong Yixin oral liquid is derived from the experience of national medical master Ren Jixue in treating viral myocarditis （VMC）. It has the functions of tonifying Qi， nourishing the heart，calming the mind， and relieving palpitations. It is used to treat VMC and angina pectoris of coronary heart disease caused by deficiency of both Qi and Yin. However，the understanding of its efficacy evidence， advantageous aspects， dosage and administration， and medication safety remains insufficient in clinical practice. Therefore，the development of the Expert Consensus on the Clinical Application of Qidong Yixin Oral Liquid （hereinafter referred to as consensus） was initiated. Consensus strictly followed the process and methods of the expert consensus on the clinical application of Chinese patent medicines of the China Association of Chinese Medicine，successively completing multiple tasks such as the consensus project initiation，determination of clinical problems，evidence search and evaluation，formation of recommendation opinions and consensus suggestions，solicitation of opinions，peer review， submission for review and release， and so on. Consensus formed a total of 10 recommendation opinions and 12 consensus suggestions，clarifying the clinical positioning，efficacy advantages，syndrome differentiation，dosage and administration，combination therapy，timing of medication，adverse reactions，contraindications， and precautions of Qidong Yixin oral liquid，indicating that it has good clinical advantages and safety in the treatment of VMC and angina pectoris of coronary heart disease，providing norms and references for physicians to safely and rationally apply Qidong Yixin oral liquid. Consensus was reviewed and approved for release by the Standardization Office of the China Association of Chinese Medicine on December 23， 2024. Standard number：GSCACM-376-2024.

BACKGROUND: G protein-coupled receptor kinase 2 (GRK2) could participate in the regulation of diverse cells via interacting with non-G-protein-coupled receptors. In the present work, we explored how paroxetine, a GRK2 inhibitor, modulates the differentiation and activation of immune cells in rheumatoid arthritis (RA). METHODS: The blood samples of healthy individuals and RA patients were collected between July 2021 and March 2022 from the First Affiliated Hospital of Anhui Medical University. C57BL/6 mice were used to induce the collagen-induced arthritis (CIA) model. Flow cytometry analysis was used to characterize the differentiation and function of dendritic cells (DCs)/T cells. Co-immunoprecipitation was used to explore the specific molecular mechanism. RESULTS: In patients with RA, high expression of GRK2 in peripheral blood lymphocytes, accompanied by the increases of phosphatidylinositol 3 kinase (PI3K), protein kinase B (AKT), and mammalian target of rapamycin (mTOR). In animal model, a decrease in regulatory T cells (T regs ), an increase in the cluster of differentiation 8 positive (CD8 + ) T cells, and maturation of DCs were observed. Paroxetine, when used in vitro and in CIA mice, restrained the maturation of DCs and the differentiation of CD8 + T cells, and induced the proportion of T regs . Paroxetine inhibited the secretion of pro-inflammatory cytokines, the expression of C-C motif chemokine receptor 7 in DCs and T cells. Simultaneously, paroxetine upregulated the expression of programmed death ligand 1, and anti-inflammatory cytokines. Additionally, paroxetine inhibited the PI3K-AKT-mTOR metabolic pathway in both DCs and T cells. This was associated with a reduction in mitochondrial membrane potential and changes in the utilization of glucose and lipids, particularly in DCs. Paroxetine reversed PI3K-AKT pathway activation induced by 740 Y-P (a PI3K agonist) through inhibiting the interaction between GRK2 and PI3K in DCs and T cells. CONCLUSION Paroxetine exerts an immunosuppressive effect by targeting GRK2, which subsequently inhibits the metabolism-related PI3K-AKT-mTOR pathway of DCs and T cells in RA.
G-Protein-Coupled Receptor Kinase 2/metabolism* ; Arthritis, Rheumatoid/immunology* ; Animals ; Dendritic Cells/metabolism* ; Paroxetine/therapeutic use* ; Proto-Oncogene Proteins c-akt/metabolism* ; Mice ; Humans ; Mice, Inbred C57BL ; Signal Transduction/drug effects* ; Male ; Phosphatidylinositol 3-Kinases/metabolism* ; Lymphocyte Activation/drug effects* ; Female ; T-Lymphocytes/metabolism* ; Middle Aged

Objective To explore factors affecting blood pressure control in chronic disease patients in China's na-tional basic public health service chronic disease patient management program and to find their relationships with Bayesian network(BN)model,in order to provide a scientific basis for comprehensive hypertension management.Methods 5 577 Hypertensive patients were selected from eight provinces(including autonomous regions)covering eastern,central and western parts of China during a survey from 2021 to 2022.Researchers collected individual and community-management data to screen influencing factors by Logistic regression,and to describe factor dependencies and to identify key determinants of blood pressure control with BN in.blood pressure control.Results Logistic regression revealed that urban/rural status,education,alcohol use,exercise,overweight/obesity and com-munity-doctor advice on salt reduction,smoking cessation were significantly associated with blood pressure control(P＜0.05).The BN model identified 22 directed edges showing that urban residence and good hypertension knowl-edge were more correlated with better control,while community-doctor management and services directly affected patient lifestyle habits but not blood pressure control.Conclusions Research should focus more on urban-rural dis-parities and hypertension education.Additionally,improving patient habits and community-doctor services is essen-tial for better blood pressure control.

Objective To study the anesthetic effects of cervical plexus C4 transverse process block one-point method under ultrasound guidance in internal fixation of clavicle fracture.Methods Eighty patients with clavicle fracture admitted to Suqian Traditional Chinese Medicine Hospital from October 2019 to October 2021 were randomly assigned(1∶1)to control group,or experimental group according to radom number table.The control group was anesthetized by cervical plexus C4 transverse process block one-point method with blind exploration,while the experimental group was anesthetized by cervical plexus C4 transverse process block one-point method under ultrasound guidance.The completion time of nerve block and surgical time were compared between the 2 groups.The hemodynamics(heart rate[HR],mean artery pressure[MVP]),and analgesic effects(visual analogue scale[VAS])before anesthesia(T0),during surgical skin incision(T1),fracture reduction(T2),and during surgical skin suture(T3)were also compared between the 2 groups.The anesthetic efficacy and anesthesia-related adverse reactions were statistically analyzed.Results There were no significant differences in surgical time between the 2 groups(P>0.05).The completion time of nerve block in the experimental group was significantly shorter than that in the control group(P<0.05).There were significant differences in the levels of HR and MAP at different time points of the 2 groups,when comparisons were made between the 2 groups(P<0.05).There were no significant differences in the levels of HR or MAP,when comparisons were made between the 2 groups at T0(P>0.05).The levels of HR and MAP in the experimental group at T1,T2,and T3 were significantly lower than those in the control group(P<0.05).The levels of HR and MAP at T1,T2,and T3 in the control group were significantly higher than those at T0(P<0.05).However,there were no significant differences in the levels of HR or MAP,when comparisons were made at different time points in the experience group(P>0.05).There were significant differences in VAS scores,when comparisons were made between different groups,at different time points,at different time points between groups(P<0.05).There were no significant differences in VAS scores,when comparisons were made between the 2 groups at T0(P>0.05).The VAS scores of the experimental group at T1,T2,and T3 were significantly lower than those of the control group(P<0.05),and the VAS scores of the 2 groups at T1,T2,and T3 were significant differences lower than those at T0(P<0.05).The effective anesthetic rate of the experimental group was 95.00%and that of the control group was 82.50%,with statistical significance,when comparisons were made between the 2 groups(P<0.05).There were no singificant differences in the incidences of phrenic nerve block,recurrent laryngeal nerve block,or Horner syndrome,when comparisons were made between the 2 groups(P>0.05).The incidence of vascular injury in the experience group was significantly lower than that in the control group(P<0.05).Conclusion The application of cervical plexus C4 transverse process block one-point method under ultrasound guidance in clavicular fracture internal fixation can shorten the completion time of nerve block,maintain hemodynamic stability,improve analgesic effect,with good anesthetic effects.Furthermore,it can reduce the incidence of adverse reactions of vascular injury.

Objective:To establish an index that can reflect the level of healthy aging promotion in a region.Methods:Establish an indicators system using expert consultation and then determine the weight for each indicator using the analytic hierarchy process. Finally, we can get the regional healthy aging promotion index.Results:Regional healthy aging promotion indicator system was established, including five first-level indicators (residence environment, medical service, public health, nurse and care, and supporting system) and 21 second-level indicators. The weight of every level-one indicator ranges from 0.073 to 0.346. Two indicators with the highest weight are residence environment and public health (0.346 and 0.325, respectively), while the indicator with the lowest weight is nurse and care (0.073). The importance of every level-two indicator ranges from 0.011 to 0.162. The consistency ratio of the regional healthy aging promotion index is 0.021, and the consistency test is qualified.Conclusion:Regional healthy aging promotion index established in this study is very scientific, reasonable, and applicable. It can be used to evaluate the region's situation or level of healthy aging promotion.

[ ABSTRACT] AIM:To investigate the expression of calprotectin ( CALP) in the rats with renal ischemia-reperfu-sion injury ( IRI) .METHODS:Male Sprague-Dawley rats were randomly divided into sham operation and IRI group ( n=25 in each group) .Blood samples and the kidneys were obtained at 6 h, 12 h, 24 h, 48 h and 72 h after reperfusion.The pathological changes of the kidneys were observed.The serum concentrations of blood urea nitrogen ( BUN) and serum cre-atinine (SCr) were measured.The serum levels of CALP, tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were detected by ELISA, and the expression of CALP, Toll-like receptor 4 ( TLR4) and NF-κB p65 in the renal tissues were de-termined by the methods of immunohistochemistry and Western blot.RESULTS: Different serial ischemia changes were observed in the renal tissues, mainly in the renal tubular epithelial cells and the mesenchyma, with the infiltration of in-flammatory cells.The serum levels of BUN, SCr, CALP, TNF-αand IL-6 in IRI group were markedly increased as com-pared with sham group (P<0.05).The protein expression of CALP, TLR4 and NF-κB p65 in the renal tubular epithelial cells in IRI group was greatly enhanced in comparison with that in sham group ( P<0.05) .CONCLUSION:The serum concentrations of CALP, TNF-αand IL-6, and the protein expression levels of CALP, TLR4 and NF-κB p65 in the renal tissue are significantly increased in the rats with IRI, suggesting that calprotectin plays an important role in the inflamma-tion in rats with IRI.

[ ABSTRACT] AIM:To investigate the role of the Notch pathway in Toll-like receptor 4 ( TLR4 )-mediated in-flammatory response in renal ischemia reperfusion injury ( IRI) in rats.METHODS: A total of 75 male sprague-Dawley rats were randomly divided into sham operation group , IRI group and DAPT treatment group .Blood samples and the kid-neys were obtained at 6 h, 12 h, 24 h, 48 h and 72 h after reperfusion .The concentrations of blood urea nitrogen ( BUN) and serum creatinine (Scr) were measured.The serum levels of tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were detected by ELISA, and the expression of Notch1, TLR4 and NF-κB p65 in the renal tissues was assessed by im-munohistochemistry and Western blot .RESULTS: The serum levels of BUN, Scr, TNF-αand IL-6 in IRI group were markedly increased as compared with sham group (P<0.05).The protein levels of Notch1, TLR4 and NF-κB p65 in re-nal tubular epithelial cells in IRI group was significantly enhanced as compared with sham group ( P<0.05 ) .In DAPT group, the serum levels of BUN, Scr, TNF-αand IL-6 were significantly reduced compared with IRI group (P<0.05), and the protein levels of Notch1, TLR4 and NF-κB p65 were apparently less than those in IRI group (P<0.05).CON-CLUSION:Significant changes of renal function , a rise of serum inflammatory factor including TNF-αand IL-6 and en-hanced expression of Notch 1, TLR4 and NF-κB p65 in the renal tissue occurred in the rats with IRI .γ-Secretase inhibitor DAPT attenuates TLR4-mediated inflammatory response in the renal IRI through the inhibition of Notch 1 and down-regula-tion of NF-κB.

Objective To investigate the influence of pre-administration of flurbiprofen on the hyperalgesia after remifentanil anesthesia.Methods This study included a total of 96 patients with abdominal surgery in the department of general surgery of our hospital.According to the random number table method,they were divided into 4 groups (n =24).Flurbiprofen axetil 1.5 mg/kg was injected intravenously before anesthesia in groups A1 and A2,flurbiprofen axetil was not injected in-travenously before anesthesia in groups B1 and B2.Anesthesia was maintained with infusion of remifentanil 0.1 μg·kg-1 ·min-1 in groups A1 and B1 0.4 μg·kg-1 ·min-1 in groups A2 and B2. The spontaneous breathing recovery time, consciousness recovery time,extubation time and anesthesia recover period of nausea,vomiting,restlessness and pain VAS scores were recorded. Results There was no significant difference in breath recovery time,consciousness recovery time and extubation time between the four groups.VAS score (9.0±1.8)was the highest in group B2,VAS score was significantly higher than the other three groups (P <0.05).VAS score (3.1±1.1)was the lowest in group A1, which was significantly lower than the other three groups (P < 0.05 ). Conclusion Pre-application of flurbiprofen 1.5 mg/kg can reduce postoperative hyperalgesia after remifentanil anesthesia in patients undergoing abdominal surgery.