ObjectiveTo evaluate the efficacy of TCM health management based on tertiary management system for patients with myocardial infarction （MI）. MethodsA total of 277 patients with non-acute MI were enrolled and given comprehensive TCM health management strategies including health education， lifestyle adjustment， risk factors control， medication and TCM appropriate techniques management through a tertiary management system with "the patient as the core， village/community physicians as the main executive body， and tertiary TCM hospital specialists as the leading body"， for a period of 12 months by using a prospective single-arm cohort study. Through patient reporting and medical records surveys， various indicators before and after 12-month management were collected and compared. The primary efficacy indicators were readmission rate and recurrent exacerbation rate， and the secondary efficacy indicators included disease awareness-related indicators， lifestyle behavior-related indicators， cardiovascular risk factor-related indicators and Canadian cardiovascular society （CCS） cardiac function classification. ResultsA total of 255 patients completed the study and were included in the final analysis. The recurrent exacerbation and readmission rates of patients after management were 23.14% （59 cases） and 20.25% （49 cases）， respectively， significantly lower than 36.08% （92 cases） and 53.72% （130 cases） before management （P＜0.05）. Except for knowledge on diabetes diagnostic criteria with no significant difference before and after management （P＞0.05）， awareness of other knowledge with regard to the prevention and treatment of cardiovascular and cerebrovascular diseases were improved after management （P＜0.01）， as well as the total score （P＜0.01）. In terms of daily life behaviors， the rates of salty diet， sweet diet and greasy diet were significantly lower than baseline， while the rate of moderate exercise was significantly higher （P＜0.05 or P＜0.01）； the rates of ongoing smoking and vigorous exercise were not significantly changed （P＞0.05）. For cardiovascular risk factors， patients' total cholesterol， low-density lipoprotein （LDL） cholesterol， triglycerides， fasting glucose， total depression assessment scale score， and total anxiety assessment scale score were significantly reduced after management （P＜0.01）. Systolic blood pressure and body mass index （BMI） were both higher after management （P＜0.05 or P＜0.01）， and there was no statistically significant difference in diastolic blood pressure （P＞0.05）. In terms of the cardiovascular disease risk factors reaching the standard levels， the rate of LDL cholesterol ＜1.8 mmol/L significantly increased （P＜0.01）， while the rate of BMI ＜24 kg/m² and the rate of systolic blood pressure ＜140 mmHg both decreased significantly （P＜0.05 or P＜0.01） from baseline； the diastolic blood pressure and rate of fasting glucose ＜7.0 mmol/L were not significantly changed （P＞0.05）. The patients' CCS cardiac function classification was significantly reduced （P＜0.05）. ConclusionTCM health management based on the tertiary management system can enhance MI patients' awareness of the disease， change poor lifestyle habits， reduce risk factors such as blood lipids and blood glucose， improve anxiety and depression， increase activity tolerance， and reduce their recurrence exacerbation and readmission rates， which is worthy of clinical promotion.

AIM:Using bioinformatics analysis methods to identify the hub genes involved in myocardial isch-emia-reperfusion injury(MIRI).METHODS:Firstly,the rat MIRI related dataset GSE122020,E-MEXP-2098,and E-GEOD-4105 were downloaded from the database.Secondly,differentially expressed genes(DEGs)were screened from each dataset using the linear models for microarray data(limma)package,and robust DEGs were filtered using the robust rank aggregation(RRA)method.In addition,the surrogate variable analysis(SVA)package was used to merge all datas-ets into one,and merged DEGs were screened using the limma package.The common DEGs were obtained by taking the intersection of the two channels of DEGs.Next,the protein-protein interaction(PPI)network of common DEGs was con-structed,and the hub genes were identified using the density-maximizing neighborhood component(DMNC)algorithm.The receiver operating characteristic curve(ROC)was plotted to evaluate the diagnostic performance of the hub gene.Then,the mRNA and protein expression levels of hub genes were detected in the rat MIRI model,and the literature re-view analysis was carried out on the involvement of hub genes in MIRI.Finally,the gene set enrichment analysis(GSEA)was performed on hub gene to further reveal the possible mechanism in mediating MIRI.RESULTS:A total of 143 robust DEGs and 48 merged DEGs were identified.After taking the intersection of the two,48 common DEGs were obtained.In the PPI network of common DEGs,5 hub genes were screened out,namely MYC proto-oncogene bHLH transcription fac-tor(MYC),prostaglandin-endoperoxide synthase 2(PTGS2),heme oxygenase 1(HMOX1),caspase-3(CASP3),and plasminogen activator urokinase receptor(PLAUR).The ROC results showed that the area under the curve values for all hub genes were greater than 0.8.MYC,PTGS2,CASP3,and PLAUR showed high mRNA and protein expression in rat MIRI,while there was no difference in mRNA and protein expression for HMOX1.The literature review revealed that among the 5 hub genes,only PLAUR has not been reported to be involved in MIRI.The GSEA results for PLAUR indicat-ed that its functional enrichment mainly focused on pathways such as NOD-like receptor signaling pathway,P53 signaling pathway,Toll-like receptor signaling pathway,apoptosis,and fatty acid metabolism.CONCLUSION:MYC,PTGS2,CASP3,HMOX1,and PLAUR are involved in the pathological process of MIRI.PLAUR is a potential hub gene that can mediate MIRI by regulating pathways such as NOD like receptor signaling,P53 signaling,Toll like receptor signaling,cell apoptosis,and fatty acid metabolism.The results can provide reference for further investigation into the molecular mechanisms and therapeutic targets of MIRI.

Objective:To investigate the application effect of 3D digital modeling combined with 3D printed model in assisting the classroom theoretical teaching of orthopedics in five-year undergraduate students majoring in clinical medicine.Methods:In May 2022, 33 five-year undergraduate students majoring in clinical medicine in the class of 2018 in Southwest Medical University were selected and divided into experimental group with 17 students and control group with 16 students according to the odd or even student number. The students in the experimental group were taught by traditional PPT+3D digital modeling combined with 3D printed model, and those in the control group were taught by the traditional PPT teaching method. The teaching effect was evaluated by theoretical examination and a questionnaire survey on the degree of satisfaction with teaching. SPSS 25.0 was used to perform the t-test, the Mann-Whitney U test, the rank sum test, and the chi-square test. Results:The experimental group had a significantly higher score of theoretical examination than the control group (86.24±4.16 vs. 82.50±6.06). The questionnaire survey on the degree of satisfaction with teaching showed that compared with the control group, the experimental group had a significantly higher degree of satisfaction with the understanding and learning of orthopedic diseases [3 (2, 3) vs. 2 (2, 2), P < 0.05], the improvement in learning interest [2 (2, 3) vs. 2 (1, 2), P < 0.05], classroom innovation [3 (3, 3) vs. 2 (1.5, 2), P < 0.05], and overall classroom teaching [3 (2, 3) vs. 2 (2, 2), P < 0.05]. Conclusion:In assisting the classroom theoretical teaching of orthopedics in undergraduate students majoring in clinical medicine, 3D digital modeling combined with 3D printed model can provide concrete 3D models, reduce the difficulties in learning, improve the awareness of orthopedic diseases, strengthen learning interest, and increase the degree of satisfaction with teaching and academic scores.

Objective To explore the medication rules of clinical prescriptions of Chinese medicine in the treatment of heart failure with diuretic resistance based on data mining method.Methods Seven domestic and foreign databases,including CNKI and Wanfang,were searched for literature on Chinese medicine for heart failure with diuretic resistance from the establishment of the database to October 2021.Frequency analysis,association rule analysis and cluster analysis were used for statistical analysis.Results A total of 41 literatures were included,including 39 prescriptions.Yang deficiency and water retention were the main symptoms of the disease.A total of 72 single herbs were used,with a total of 438 times of use.There are 30 Chinese medicines with a frequency of more than 5 times,involving 9 efficacy categories,mainly tonic medicines,diuresis and dampness medicines,blood-activating and stasis-removing medicines,and interior-warming medicines.The association rule analysis yielded drug compatibility with Poria as the core,such as Atractylodis Macrocephalae Rhizoma→Poria and Cinnamomi Ramulus→Poria.Cluster analysis yielded six new formula combinations with efficacy in warming Yang,inducing diuresis,benefiting qi and invigorating Blood.Conclusion Heart failure with diuretic resistance is a syndrome of root vacuity and tip repletion,cold-heat complex,and the core pathogenesis is"deficiency","water"and"stasis".The treatment of this disease occurs by warming yang and excreting water,supplemented by replenishing qi and activating blood circulation.Poria with Atractylodis Macrocephalae Rhizoma and Cinnamomi Ramulus are commonly used combinations,and Zhen Wu Decoction is the basic formula for the treatment of this disease.

The thyroid function test is universally used for the evaluation of thyroid function. However, there are factors other than endocrine diseases, such as special physiological conditions, interference in laboratory measurement, or disorders in other systems that should be taken into consideration. When encountering thyroid function test results that are not in line with clinical manifestation, a comprehensive evaluation is essential for a correct and timely diagnosis. We presented a case of a significant rise in serum total triiodothyronine(TT 3) secondary to multiple myeloma. Through case studies and literature review, we intended to provide clinicians with experience for better interpretation of abnormal thyroid function test results.

Objective: This study aimed to evaluate the clinical performance of p16/Ki-67 dual staining for triage high risk HPV (HR-HPV) infected women. Method: Target objects were women who infected HR-HPV and received colposcopy examination between April and December of 2016 at the Second Affiliated Hospital of Zhengzhou University. Gynecologists collected the cervical exfoliated cells from eligible women for p16/Ki-67 dual staining, LBC testing and HPV DNA testing. Histology diagnosis were used as gold standard. Sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs) of p16/Ki-67 dual staining, LBC testing and HPV16/18 testing for triage of HR-HPV positive population were calculated and compared. Results: A total of 295 HR-HPV infected women were selected, and the mean age was (44.29±11.48) years old. Positive rates of p16/Ki-67 dual staining, HPV16/18 testing and LBC testing were 70.17% (207), 56.95% (168) and 85.76% (253), respectively. When CIN2+as the endpoint, among the three triage methods, sensitivity of p16/Ki-67 dual staining was 90.00% (95%CI: 85.06%-93.43%), higher than the value of HPV 16/18 testing, but lower than the value of LBC testing. Specificity, PPV and NPV of p16/Ki-67 dual staining were the highest [71.58% (95%CI: 61.81%-79.67%), 86.96% (95%CI:81.69%-90.88%) and 77.27% (95%CI: 67.49%-84.78%)]. When detection for CIN3+, sensitivity of p16/Ki-67 dual staining was 92.90% (95%CI: 87.74%-95.99%), lower than the value of LBC testing, but higher than the value of HPV16/18 testing. Specificity of p16/Ki-67 dual staining was 55.00% (95%CI: 46.74%-63.00%), lower than the value of HPV16/18 testing, but higher than the value of LBC testing. PPV of p16/Ki-67 dual staining was 69.57% (95%CI: 62.99%-75.43%), lower than the value of HPV 16/18 testing, but higher than the value of LBC testing. NPV of p16/Ki-67 dual staining was 87.50% (95%CI: 78.99%-92.87%), higher than value of HPV 16/18 testing, but lower than the value of LBC testing. Conclusion p16/Ki-67 dual staining has better clinical effects than HPV 16/18 testing and LBC testing for triage women with HR-HPV infection.

Objective:To investigate and analyze the clinical characteristics of chronic liver injury and glutathione treatment in patients with coal-burning-borne arsenism.Methods:A total of 71 patients with liver injury caused by coal-burning-borne arsenism admitted to Binzhou People's Hospital from March 2017 to December 2018 were randomly divided into observation group (37 cases) and control group (34 cases) by lottery. Both groups of patients were given routine treatment, including intravenous infusion of compound amino acids, oral administration of B vitamins, etc., and intravenous infusion of 5.0 g of vitamin C mixture dissolved in 250 ml of 5% glucose, once a day, treatment for 4 weeks. In addition, the observation group was given an intravenous infusiondrip of 1.8 g of glutathione dissolved in 250 ml of 5% glucose, once a day, for 4 weeks. The clinical characteristics of the patients were observed, and the changes of liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL)], serum antioxidant indexes [malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)], and clinical efficacy before and after the treatment were compared between the two groups.Results:In 71 coal-burning-borne arsenism patients with liver injury, the abnormal rate of electrocardiogram (ECG) examination was 64.79% (46/71), and the abnormal rate of chest X-ray examination was 26.76% (19/71). After treatment, the liver function indexes ALT, AST, TBIL and DBIL decreased in both groups [observation group before treatment: (131.82 ± 25.62), (109.84 ± 26.28) U/L, (81.47 ± 20.93), (57.38 ± 15.25) μmol/L; observation group after treatment: (58.93 ± 12.03), (51.20 ± 10.57) U/L, (25.66 ± 7.94), (16.49 ± 4.92) μmol/L; control group before treatment: (128.95 ± 31.20), (107.39 ± 29.81) U/L, (83.21 ± 17.95), (55.39 ± 16.30) μmol/L; control group after treatment: (76.42 ± 15.73), (74.33 ± 14.80) U/L, (36.72 ± 9.32), (23.74 ± 7.35) μmol/L, P < 0.05], and the liver function indexes in the observation group were significantly lower than those in the control group after treatment ( P < 0.05). The serum antioxidant indexes MDA, SOD and GSH-Px in the two groups were significantly increased after treatment [observation group before treatment: (25.47 ± 3.98) μmol/L, (85.72 ± 23.54), (1 729.84 ± 379.50) U/L; observation group after treatment: (46.31 ± 7.49) μmol/L, (122.31 ± 28.53), (2 410.29 ± 512.31) U/L; control group before treatment: (26.02 ± 4.11) μmol/L, (84.95 ± 21.03), (1 749.52 ± 405.28) U/L; control group after treatment: (38.92 ± 6.27) μmol/L, (103.12 ± 25.68), (2 097.42 ± 478.52) U/L, P < 0.05], and the serum antioxidant indexes in the observation group were significantly higher than those in the control group after treatment ( P < 0.05). The total effective rate of the observation group was significantly higher than that of the control group [91.89% (34/37) vs 76.47% (26/34), χ 2 = 4.254, P < 0.05]. Conclusions:Coal-burning-borne arsenism patients with chronic liver injury may have multiple system injury at the same time. Glutathione can effectively improve the clinical symptoms and liver function of patients. Its effect may be related to the improvement of antioxidant function, which is worthy of clinical promotion.

Acute Disease ; Glucocorticoids ; Graft Rejection ; Heart Rate ; Humans ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Liver Transplantation

Objective To understand the species,species distribution,the dominant species and their interspecies interaction of chigger mites on Eothenomys miletus(a dominant species of rats)in Yunnan.Method The rats were captured with mouse traps in 16 counties(or cities)during 2000-2004.All mites on the surface of two auricles of the hosts were collected and identified.The patch index(m*/m)and the coefficient of association(V)were adopted to judge the spatial distribution patterns and interspecies interaction of the dominant chigger mite species among different individuals of the rats(E.miletus).Results 1157 individuals of E.miletus were captured from 16 counties(citys).37613 chigger mites(belonging to 3 subfamily,9 genus and 80 species)were collected from the auricles(body surface)of 1157 rat hosts with a high “overall mite infestation rate”(68.2%)and “overall mite index”(32.5).Six species of mites were found dominant on E.miletus:Leptotrombidium scutellare,Leptotrombidium sinicum,Helenicula simena,Leptotrombidium eothenomydis,Herpetacarus hastoclavus and Leptotrombidium hiemalis.The distribution of the chigger mites among different individuals of E.miletus showed an aggregation pattern.Both positive and negative association existed between each two dominant species of chigger mites.Conclusion The species composition of chigger mites on Eothenomys miletus is complex with abundant individuals,which reflects a high species diversity of the mites.The main species of chigger mites tend to an aggregation on the body surface of E.miletus.

Leptotrombidium eothenomydis.There was a wide niche overlap between any two chigger species with all indices beyond 0.76.Slight positive association existed between each two dominant species of chigger mites by the coefficient of association(V).Conclusion The community structure of chigger mites on the 7 major species of rodent hosts is complex,reflecting a high diversity of mite species.The niche breadth of the 6 dominant chigger species is different with a wide niche overlap.