AIM: To evaluate the surgical outcomes and changes in the ocular surface microenvironment following radiofrequency minimally invasive treatment for conjunctivochalasis-induced epiphora.METHODS: Patients with epiphora primarily caused by conjunctivochalasis were enrolled. All patients had conjunctivochalasis of ≥grade II, and their symptoms showed no significant improvement after previous pharmacological treatment. All patients underwent radiofrequency minimally invasive correction of conjunctivochalasis, supplemented with artificial tears, anti-inflammatory therapy, and ocular surface repair treatment postoperatively. At 8 wk post-surgery, the ocular surface disease index(OSDI), eye redness, tear secretion, non-invasive tear break-up time, lipid layer thickness, tear ferning test, and conjunctival impression cytology were assessed to compare treatment efficacy and observe changes in the ocular surface microenvironment.RESULTS: A total of 43 cases(43 eyes)of conjunctivochalasis and with a main complaint of epiphora were included, including 23 males and 20 males, with a mean age of 64.69±3.36 years. The total effective rate of surgery was 91% at 8 wk postoperatively. Compared with preoperative values, the OSDI scores significantly decreased and the non-invasive tear break-up time was prolonged at 8 wk post-surgery(all P<0.05). No statistically significant differences were observed in lipid layer thickness or tear secretion at 8 wk postoperatively(all P>0.05). The normal rate of chloramphenicol taste test increased from 21% preoperatively to 63% postoperatively; the normal rate of eye redness increased from 40% to 70%; normal rate of tear ferning grading improved from 30% to 63%; and normal conjunctival impression cytology grading increased from 21% to 74%.CONCLUSION: Radiofrequency minimally invasive treatment is effective for conjunctivochalasis and is straightforward to perform. Patients with conjunctivochalasis often present with other ocular surface issues beyond conjunctivochalasis itself, such as insufficient tear secretion, reduced lipid layer thickness, and other dry eye-related problems. Therefore, a comprehensive approach emphasizing tear dynamics should be adopted during treatment.

OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objective:To analyze the relationship between 24-hour urinary calcium (24 h UCa) level and the risk of end-stage kidney disease (ESKD), cardiovascular disease (CVD), and all-cause mortality.Methods:In the Chinese Cohort Study of Chronic Kidney Disease, we examined 3 375 patients aged 18-74 years with CKD stages 1-4. Kaplan-Meier survival and Cox proportional hazard regression models were used to test a time-to-event association between levels of 24 h UCa and incidence of ESKD, CVD, and all-cause mortality.Results:During a follow-up of 4.17 (3.37, 5.20) years, 179, 145, 104 and 38 ESKD events occurred in <0.60, 0.60-, 1.20-, ≥2.32 mmol 24 h UCa groups. Higher levels of 24 h UCa (1.20-,≥2.32 mmol) were independently associated with a lower incidence of ESKD events in patients with CKD, with HR (95% CI) of 0.71 (0.54-0.93) and 0.43 (0.29-0.64), respectively. No significant associations with CVD and all-cause mortality endpoints were detected. Conclusion:Among patients with CKD, levels of 24 h UCa displayed an association with the risk of ESKD among patients with CKD stages 1-4.

The construction of the close-knit medical consortium is the starting point for realizing hierarchical diag-nosis and treatment,and the construction of the close-knit medical consortium requires the formation of prob-lem-oriented and interest-oriented cooperation between different types of hospitals.It selected typical cases of cooperation between different types of hospitals in the United States,Canada,Germany and Japan,and gave the key points of cooperation between different types of hospitals,such as agreement signing and cooperation frame-work,establishment of resource sharing and cooperation mechanism,expert exchange and training,case discus-sion and remote consultation,referral and continuum of care,and effect evaluation and continuous improvement.The practice of these hospital,cooperation provides a reference for the extension of high-quality urban resources to the county level in China.

Objective:To analyze the relationship between 24-hour urinary calcium (24 h UCa) level and the risk of end-stage kidney disease (ESKD), cardiovascular disease (CVD), and all-cause mortality.Methods:In the Chinese Cohort Study of Chronic Kidney Disease, we examined 3 375 patients aged 18-74 years with CKD stages 1-4. Kaplan-Meier survival and Cox proportional hazard regression models were used to test a time-to-event association between levels of 24 h UCa and incidence of ESKD, CVD, and all-cause mortality.Results:During a follow-up of 4.17 (3.37, 5.20) years, 179, 145, 104 and 38 ESKD events occurred in <0.60, 0.60-, 1.20-, ≥2.32 mmol 24 h UCa groups. Higher levels of 24 h UCa (1.20-,≥2.32 mmol) were independently associated with a lower incidence of ESKD events in patients with CKD, with HR (95% CI) of 0.71 (0.54-0.93) and 0.43 (0.29-0.64), respectively. No significant associations with CVD and all-cause mortality endpoints were detected. Conclusion:Among patients with CKD, levels of 24 h UCa displayed an association with the risk of ESKD among patients with CKD stages 1-4.

The construction of the close-knit medical consortium is the starting point for realizing hierarchical diag-nosis and treatment,and the construction of the close-knit medical consortium requires the formation of prob-lem-oriented and interest-oriented cooperation between different types of hospitals.It selected typical cases of cooperation between different types of hospitals in the United States,Canada,Germany and Japan,and gave the key points of cooperation between different types of hospitals,such as agreement signing and cooperation frame-work,establishment of resource sharing and cooperation mechanism,expert exchange and training,case discus-sion and remote consultation,referral and continuum of care,and effect evaluation and continuous improvement.The practice of these hospital,cooperation provides a reference for the extension of high-quality urban resources to the county level in China.

Objective This study aimed to clarify the anti-influenza virus activity of Bingyanqing(BYQ),as well as to explore the mechanism of BYQ in treating influenza through network pharmacology and experimental verification.Methods The impact of BYQ on mortality,lung index,and viral load in an influenza mouse model was detected.We collected the ingredients and targets of BYQ formula by searching databases including TCMSP,Swiss Target Prediction and consulting the literature.The"ingredients-common target"network for anti-influenza effect of BYQ was constructed using Cytoscape software.The protein-protein interaction(PPI)network was constructed using the STRING database and Cytoscape software,and the core targets were screened.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed for common targets.The effect of BYQ on reducing influenza-induced oxidative damage,the expression of antioxidant and pro-oxidant enzyme,P65 phosphorylation and nuclear factor E2-related factor 2(Nrf2)nuclear translocation in vivo were investigated.Results BYQ significantly reduced mortality,lung index,pulmonary viral load and lung injury in a mouse model of influenza.We obtained one hundred and ninety-three of BYQ active compounds,which corresponded to three hundred and thirty-eight targets.There are 180 influenza-related targets among them.Nine targets,including IκBα kinase α(CHUK),IκBα kinase γ(IKBKG),NF-κB p65(RELA),tumor necrosis factor(TNF)and interleukin 6(IL6),were identified as potential core targets.GO analysis indicated that BYQ is involved in several biological functions,including antibacterial and antioxidant stress responses.KEGG analysis revealed the involvement of several viral and immune-related pathways for BYQ in treating influenza,including herpes simplex virus,influenza A virus,TNFα and toll-like receptor pathways.In vivo studies showed that high-dose BYQ significantly reduced pulmonary malondialdehyde(MDA)levels(P＜0.01)and increased total superoxide dismutase(SOD)activity(P＜0.001)in a mouse mode of influenza compared to oseltamivir phosphate.The treatment group with the combination of BYQ&oseltamivir phosphate had lower levels of NADPH oxidase 2(NOX2)and 4(NOX4)(P＜0.001),and higher levels of catalase(CAT)and glutathione peroxidase 4(GPX4)(P＜0.001)in the lungs than oseltamivir phosphate group.The combined treatment group showed more significant Nrf2 nuclear translocation(P＜0.05)than the oseltamivir phosphate group.However,there was no significant difference in P65 phosphorylation levels between the combination treatment group and the oseltamivir phosphate group(P＜0.05),but P65 phosphorylation levels in both groups were lower than in the model group(P＜0.05).Conclusion BYQ exhibits significant anti-influenza virus activity,manifests a dual effect by inhibiting the synthesis of pro-oxidant enzymes and promoting the antioxidant system,thereby alleviates the oxidative stress damage caused by influenza.

AIM: To investigate the efficacy of lacrimal duct laser dacryoplasty combined with intubation and postoperative meibomian gland treatment in patients with chronic dacryocystitis complicated by meibomian gland dysfunction.METHODS: Data were collected from 128 patients with chronic dacryocystitis complicated by meibomian gland dysfunction treated at Xi'an No.1 Hospital from March 2021 to December 2022. All patients underwent lacrimal duct laser dacryoplasty combined with intubation. Postoperatively, those patients were randomly divided into two groups: group A(64 cases, without meibomian gland treatment)and group B(64 cases, with meibomian gland treatment). The lacrimal intubation was removed at 3 mo after surgery to evaluate the patency rate of lacrimal irrigation. Additionally, changes in the ocular surface disease index(OSDI)score, non-invasive tear film break-up time, tear meniscus height, conjunctival hyperemia analysis, meibomian gland analysis, tear lipid layer thickness, tear ferning test, and conjunctival impression cytology were compared between the two groups.RESULTS: The lacrimal irrigation patency rates in the group A and group B were 78.1% and 81.2% respectively, with no statistically significant difference between the two groups(P>0.05); compared with the group A, group B showed a significant extension in non-invasive tear breakup time at 3 mo after surgery, and the OSDI score, conjunctival hyperemia analysis, tear ferning test and conjunctival impression cytology grading were all significantly decreased(all P<0.05), while there was no significant difference in tear meniscus height, tear lipid layer thickness and meibomian gland loss score between the two groups(all P>0.05).CONCLUSION: Comprehensive treatment for patients with chronic dacryocystitis combined with meibomian gland dysfunction have improved patients' comfort, tear film stability, and reduces local inflammatory response. It is important to simultaneously address ocular surface microenvironment abnormalities during surgical treatment to achieve satisfactory efficacy.

Objective:To investigate the effects of continuous renal replacement therapy (CRRT) on plasma concentration, clinical efficacy and safety of colistin sulfate.Methods:Clinical data of patients received with colistin sulfate were retrospectively analyzed from our group's previous clinical registration study, which was a prospective, multicenter observation study on the efficacy and pharmacokinetic characteristics of colistin sulfate in patients with severe infection in intensive care unit (ICU). According to whether patients received blood purification treatment, they were divided into CRRT group and non-CRRT group. Baseline data (gender, age, whether complicated with diabetes, chronic nervous system disease, etc), general data (infection of pathogens and sites, steady-state trough concentration, steady-state peak concentration, clinical efficacy, 28-day all-cause mortality, etc) and adverse event (renal injury, nervous system, skin pigmentation, etc) were collected from the two groups.Results:A total of 90 patients were enrolled, including 22 patients in the CRRT group and 68 patients in the non-CRRT group. ① There was no significant difference in gender, age, basic diseases, liver function, infection of pathogens and sites, colistin sulfate dose between the two groups. Compared with the non-CRRT group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were higher in the CRRT group [APACHE Ⅱ: 21.77±8.26 vs. 18.01±6.34, P < 0.05; SOFA: 8.5 (7.8, 11.0) vs. 6.0 (4.0, 9.0), P < 0.01], serum creatinine level was higher [μmol/L: 162.0 (119.5, 210.5) vs. 72.0 (52.0, 117.0), P < 0.01]. ② Plasma concentration: there was no significant difference in steady-state trough concentration between CRRT group and non-CRRT group (mg/L: 0.58±0.30 vs. 0.64±0.25, P = 0.328), nor was there significant difference in steady-state peak concentration (mg/L: 1.02±0.37 vs. 1.18±0.45, P = 0.133). ③ Clinical efficacy: there was no significant difference in clinical response rate between CRRT group and non-CRRT group [68.2% (15/22) vs. 80.9% (55/68), P = 0.213]. ④ Safety: acute kidney injury occurred in 2 patients (2.9%) in the non-CRRT group. No obvious neurological symptoms and skin pigmentation were found in the two groups. Conclusions:CRRT had little effect on the elimination of colistin sulfate. Routine blood concentration monitoring (TDM) is warranted in patients received with CRRT.

Objective To observe the effect of Hawthorn Jiangzhi powder on blood lipids in hyperlipidemia patients.Methods Four hundreds and eighty-four patients with hyperlipidemia were selected from Department of Cardiology in Huanghuai University Affiliated Hospital from January 2011 to June 2016,and they were divided into observation group and control group by random number table,each group 242 cases.The observation group took orally Hawthorn Jiangzhi powder (including ingredients:hawthorn 6 g,salvia miltiorrhiza 18 g,black soybean 16 g,hoelen 6 g,ganoderma lucidum 9 g,kudzuvine root 6 g,Chinese yam 6 g,fructus amomum 9 g,coix seed 16 g,cassia seed 6 g) once 6-9 g powder,twice a day,once in the morning and another in the evening;the control group was given simvastatin,20 mg each day during taking dinner;the therapeutic period lasted 2 months in both groups.The differences in serum lipid and serum inflammatory factor levels were compared before and after treatment in the two groups;the changes of lymphocyte subsets of the two groups were observed and compared with the changes of the subset results of 100 normal healthy subjects aged 35-80 years old in the same period in our hospital,and the total efficiency,the situations of adverse reactions and liver and kidney functions of two groups were observed.Results In the observation group and the control group,before treatment the levels of CD4+,CD8+,CD4+/CD8+ were lower than those of healthy control group,but after treatment the levels of CD4+,CD8+ and CD4+/CD8+ were higher than those before treatment,and the changes of the observation group were more significant than those of the control group(CD4+:0.47±0.11 vs.0.40±0.10,CD8+:0.28 ± 0.10 vs.0.26 ± 0.08,CD4+/CD8+:1.67 ± 0.79 vs.1.53 ± 0.45);After treatment,the levels of hypersensitive C-reactive protein (hs-CRP),interleukin-6 (IL-6),von Willebrand factor (vWF) and homocysteine (Hcy) in the two groups were significantly lower than those before treatment,and the levels of hs-CRP,IL-6 and vWF in the observation group were obviously lower than those in the control group [hs-CRP (mg/L):5.1 ± 1.8 vs.5.8 ± 1.7,IL-6 (ng/L):2.9 ± 1.6 vs.3.7 ± 1.8,vWF:(126.8 ± 12.8)％ vs.(156.5 ± 11.3)％,all P ＜ 0.05].After treatment,Hcy in the observation group was lower than that in the control group,but there was no significant difference between the two groups (μμmol/L:5.2 ± 1.8 vs.5.4 ± 2.6,P ＞ 0.05).In the observation group after treatment at each time point,the levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were lower than those before treatment,while the levels of high density lipoprotein cholesterol (HDL-C) and high density lipoprotein cholesterol/total cholesterol (HDL/TC) were higher than those before treatment;after treatment in the control group,the levels of TC,TG and LDL-C were decreased,and the levels of HDL-C and HDL/TC were obviously increased compared with those before treatment;The levels of TC,TG and LDL-C in the observation group after treatment for 2 months were significantly lower than those in the control group [TC (mmol/L):1.26 ± 0.57 vs.2.26 ± 0.56;TG (mmol/L):3.45 ± 0.78 vs.5.45 ± 0.75,LDL-C (mmol/L):2.40±0.65 vs.2.72±0.85;all P ＜ 0.05),and HDL/TC was obviously increased (1.19±0.15 vs.0.62±0.35,P ＜ 0.01).The total therapeutic effective rate of the observation group was significantly higher than that of the control group [90.1％ (218/242) vs.73.4％ (178/242),P ＜ 0.01].Adverse reactions and changes of liver and kidney functions during the period of treatment in the two groups were minimal.Conclusions Hawthorn Jiangzhi powder can effectively reduce the blood lipids and serum inflammation cytokines in patients with hyperlipidemia,improve blood rheological situation,reduce serum levels of inflammatory factors,inhibit the formation and development of atherosclerosis and enhance the immune function obviously in patients with high lipid abnormalities.