In this work, starting from 4-hydroxycoumarin, three series of 22 coumarin derivatives, among which 8 have not been reported in the literature, were synthesized and their in vitro anti-inflammatory activities and mechanisms of action were preliminarily investigated using mouse macrophage model. The results showed that most of the derivatives could significantly inhibit the production of pro-inflammatory factor NO, with compounds 2e, 2f, 2g, 2h, 2i, 2j, 4e, and 4f showing better anti-inflammatory activity than the positive control drug dexamethasone. Further experiments showed that compounds 2h and 4f significantly inhibited the production of pro-inflammatory factors IL-6, TNF-α and IL-1β in RAW264.7 macrophages, and could, therefore, be used as lead compounds for further studies.

Objective To assess the nutritional status in elderly patients with chronic renal insufficiency (CRI) and reveal the key factors affecting the nutritional status. Methods A total of 310 elderly patients with CRI who received hospitalization treatment and outpatient follow-up in the hospital from January 2021 to June 2024 were selected as the investigation subjects. The nutritional status of patients was evaluated by mini-nutritional assessment (MNA) questionnaire, and the nutritional status and dietary structure of patients were comprehensively evaluated by anthropometric indicators [height, weight, body mass index (BMI), upper arm circumference, calf circumference], biochemical indicators [serum albumin (ALB), prealbumin (PA), hemoglobin (Hb), transferrin (TF)] and 24-hour dietary review method. According to the investigation results of nutritional status, the patients were divided into good nutrition group (MNA score≥24 points), nutritional risk group (MNA score of 17-23.5 points) and malnutrition group (MNA score<17 points). Univariate analysis was adopted to screen the potential influencing factors of elderly CRI. Multivariate logistic regression model was applied to analyze the influencing factors of malnutrition in elderly CRI patients. Results Among the 325 questionnaires were distributed, but only 310 valid questionnaires were recovered, with an effective recovery rate of 95.38%. Investigation results revealed that among the 310 patients, 29.35% (91 cases) had good nutritional status, and 42.26% (131 cases) had nutritional risk, and 28.39% (88 cases) had malnutrition. Univariate analysis indicated that there were statistical differences in BMI, CRI staging, serum ALB, PA, Hb, TF, protein intake and total calorie intake among the good nutrition group, the nutritional risk group and the malnutrition group (P<0.05). Multivariate logistic regression analysis suggested that low BMI (OR=0.903, 95%CI: 0.867-0.941), high CRI stage (OR=1.091, 95%CI: 1.053-1.130), low serum ALB (OR=0.907, 95%CI: 0.867-0.948), PA (OR=0.918, 95%CI: 0.888-0.949), Hb (OR=0.944, 95%CI: 0.909-0.997), TF (OR=0.912, 95%CI: 0.874-0.952), insufficient protein intake (OR=0.924, 95%CI: 0.882-0.969) and insufficient total calorie intake (OR=0.938, 95%CI: 0.909-0.968) were influencing factors for malnutrition in elderly patients with CRI (all P<0.05). Drawing ROC curve of malnutrition in elderly patients with CRI according to the prediction probability of logistic regression model found that the AUC, sensitivity, specificity, 95%CI and Youden index were 0.976, 93.18%, 92.34%, 0.953-0.990 (P<0.05) and 0.855. Conclusion The incidence rate of malnutrition is high in elderly patients with CRI, and is mainly affected by factors such as low BMI, high CRI stage, low serum ALB, PA, Hb and TF levels and insufficient protein and total calorie intakes. In addition, logistic regression model has high predictive value and can provide a reference for early clinical identification of high-risk population with malnutrition among elderly patients with CRI.

OBJECTIVE: To explore the feasibility of establishing a temporary trauma team led by trauma experts in primary hospitals for disaster medical rescue. METHODS: In the coal mine flooding accident in Xiaoyi City, Shanxi Province on December 15, 2021, according to the local emergency plan and the characteristics of the accident, the trauma experts trained the medical staff from the local primary hospital on advanced trauma life support (ATLS) and damage control surgery (DCS) in the short time interval between the occurrence of the mine disaster and the admission of medical staff to the disaster scene. A temporary trauma team composed of trauma experts, ATLS team, and DCS team was formed to provide early diagnosis and treatment for survivors before and in the hospital. RESULTS: The miners were found on the 36th hour of the disaster. All 22 miners were male, and 2 died underground. Another 20 people were rescued 39－43 hours after the disaster, with a median age of 48 years (34-57 years). All the survivors suffered from hypothermia, dehydration, maceration of feet and other injuries. There were 18 cases of acute inhalation tracheobronchitis, 14 cases of electrolyte acid-base disturbance, 6 cases of trunk contusion, 1 case of psoas major hematoma, and 1 case of lower extremity hematoma. Deep vein thrombosis was in 4 cases. The ATLS team focused on injury assessment, rewarming and rehydration within 50－60 minutes before admission, and completed auxiliary examinations within 2 hours after admission to clarify the diagnosis. The DCS team evaluated 6 patients with mechanical blunt trunk injury and excluded the indication of emergency surgery. The trauma experts conducted the whole process of supervision and quality control of disaster rescue. The positive rate of capillary refill test in the all survivors at the third hour of admission was significantly lower than that immediately after being rescued (75.0% vs. 15.0%, P=0.000 3), and they were discharged 4－7 days after admission. CONCLUSION Under the leadership of trauma experts and relying on the medical staff of primary hospitals, it is feasible to establish and train a temporary trauma team with ATLS and DCS functions to participate in the medical rescue of disasters, which is in line with the current national conditions of China.
Humans ; Adult ; Middle Aged ; Male ; Rescue Work/organization & administration* ; China ; Disasters ; Patient Care Team/organization & administration* ; Wounds and Injuries/therapy* ; Advanced Trauma Life Support Care/organization & administration* ; Disaster Planning/organization & administration* ; Emergency Medical Services/organization & administration*

The Healthy China 2030 Plan set the goal of reducing premature deaths from diabetes by 30% by 2030. However, there has been a lack of assessment of premature mortality for diabetes since the action plan was issued. This study used data from the Global Burden of Disease Study 2021, calculated the premature deaths for diabetes by sex, provinces, and subtypes from 1990 to 2021. We explored the temporal trend of premature mortality using the average annual percent change (AAPC) for different sexes, provinces, and subtypes from 1990 to 2021. Furthermore, we predicted premature mortality for diabetes through 2030 for China and its provinces according to the average annual change rate from 2010 to 2021. There was a first slow upward trend in premature mortality for diabetes from 0.5% in 1990 to 0.6% in 2004, and then a decline until 2021 with premature mortality of 0.4%. By 2030, only Fujian (30.3%) will achieve the desired level of reduction, with only seven provinces meeting the target for females and none for males. There is a large range in the degree of decline between inland and coastal regions, showing obvious geographic differences, and there should be a focus on balancing medical resources.
Humans ; China/epidemiology* ; Female ; Male ; Mortality, Premature/trends* ; Diabetes Mellitus/mortality* ; Goals ; Middle Aged ; Adult

Objective:To investigate the effects of Xuebijing injection on gut microbiota and intestinal mechanical barrier in mice with lipopolysaccharide (LPS)-induced sepsis, and analyze the potential mechanism by which Xuebijing injection protects gastrointestinal tract.Methods:Twenty-four healthy and clean grade male C57BL/6N mice were divided into four groups, control group, LPS group, LPS+ 5 μl/g Xuebijing injection group (5 μl/g Xuebijing injection group), and LPS+ 10 μl/g Xuebijing injection group (10 μl/g Xuebijing injection group), with six mice in each group. A mouse model of sepsis was established by intraperitoneal injection of mice with 10 μg/g LPS. At 0 and 12 h after successful modeling, the mice were intraperitoneally injected with 5 or 10 μl/g Xuebijing injection. Blood, ileum, and colon fecal samples were collected 12 h after the second administration. ELISA was used to detect the levels of diamine oxidase (DAO), D-blood lactic acid (D-Lac), TNF-α, and IL-6. HE staining was used to observe the local ileum damage, and Chiu′s score was used to evaluate the degree of intestinal tissue damage. Immunohistochemical staining and Western blot were used to detect the expression of Claudin-1, Occludin, and zona occludins-1(ZO-1) in ileum tissues, followed by semi quantitative analysis. One-way analysis of variance was used for intergroup comparisons, and LSD or Tamhane′s T2 test was used for pairwise comparisons based on the homogeneity of variance. The diversity and species composition of mouse fecal microbiota, and the differences among groups were analyzed using 16S rRNA sequencing.Results:The levels of DAO, D-Lac, TNF-α, and IL-6 in the LPS group were higher than those in the control group (all P<0.000 1). After the intervention with Xuebijing injection, the levels of DAO, D-Lac, TNF-α, and IL-6 decreased (all P<0.05) and showed no significant differences with those in the control group (all P>0.05). Besides, 10 μl/g Xuebijing injection was more effective than 5 μl/g Xuebijing injection in reducing the concentrations (all P<0.05). Chiu′s score was higher in the LPS group than in the control group and the 10 μl/g Xuebijing injection group (both P<0.05). Western blot showed that the expression levels of Occludin, Claudin-1, and ZO-1 in the LPS group were lower than those in the control group (all P<0.01), and Xuebijing injection intervention significantly increased the expression levels of these proteins in a dose-dependent manner as compared with the LPS group (all P<0.000 1). Apart from the expression level of ZO-1, which showed no significant difference between the two Xuebijing injection groups ( P>0.05), the results of immunohistochemical staining were consistent with those of Western blot. The 16S rRNA sequencing results showed that there were differences in the Alpha and Beta diversity indices, and the composition and structure of gut microbiota among the four groups. The structure of gut microbiota in the mice treated with Xuebijing injection was similar to that in the mice of the control group and it was in a dose-dependent manner. Wilcoxon rank sum test showed that there were statistically significant differences in six gut microbiota groups at the phylum level, and 32 gut microbiota groups at the genus level among the mice of four groups (all P<0.05). Conclusions:Xuebijing injection can provide protective effects on the gastrointestinal tract by protecting the structure of gut microbiota and intestinal barrier function, and the protective effect is somewhat correlated with the drug dosage.

Objective:To investigate the risk of hospital death in patients with traumatic hemorrhagic shock combined with multiple organ dysfunction syndrome(MODS)predicted by discriminant analysis.Methods:This study was a single-center retrospective study. From January 2013 to May 2023, patients with traumatic hemorrhagic shock complicated with MODS admitted to Peking University People's Hospital were selected as the research objects. According to the in-hospital survival, the patients were divided into survival group (205 cases) and death group (29 cases). The general condition, injury assessment, laboratory indexes, complications and clinical scores of the two groups were compared. Wilks's Lambda stepwise discriminant analysis was used to establish a discriminant model for in-hospital death in patients with traumatic hemorrhagic shock combined with MODS. the Receiver operating characteristic curve (ROC) was drawn and the Area under the curve (AUC) was calculated. The cross-validation method was used to evaluate the accuracy of the prediction results of the established model.Results:There was a statistical difference between the survival group and the death group in terms of the main bleeding site (limbs), the time from injury to hospital admission, temperature, platelet count, prothrombin time, activated partial thrombin time, fibrinogen, albumin, serum creatinine, estimated glomerular filtration rate, uric acid, cardiac troponin I, procalcitonin, base excess, lactate to albumin ratio, glucose to albumin ratio, acute respiratory distress syndrome, acute kidney injury, acute myocardial injury, traumatic induced coagulopathy, ISS, APACHEⅡ score and SOFA scores. There are four indicators entering the final discrimination model: Prothrombin time, ISS score, estimated glomerular filtration rate, lactate to albumin ratio. The AUC for predicting the risk of death in patients with traumatic hemorrhagic shock combined with MODS was 0.791, and the 95% CI was 0.671 to 0.911. Conclusions:The established discriminant model is highly accurate in predicting the risk of hospital death in patients with traumatic hemorrhagic shock complicated with MODS. Prothrombin time, ISS score, estimated glomerular filtration rate and lactate to albumin ratio were associated with an increased risk of death from traumatic hemorrhagic shock with MODS.

AIM: To observe the preliminary application of fully automatic feedback perimeter based on the eye gaze tracking technique in the college students and to verify its test performance.METHODS: Home computer, monitor and eye tracker were used to complete the new automatic feedback perimeter meter. Based on the two characteristic eye movements of fixation and pulsation, the abnormal visual field is determined by analyzing whether the participant perceives the visual target, line-of-sight scan path and the fixation towards the visual target. RESULTS: A total of 63 participants(119 eyes)were collected with valid eye movement data. The average time for all participants was 82.46±14.68 s, the average time for right eyes was 88.21±15.30 s, and average time for the left eyes was 76.42±11.29 s(P<0.05).CONCLUSION: The fully automatic feedback perimeter based on eye gaze tracking technique can realize automatic human-computer interaction, and the detection method is simple and easy, which shortens the time of perimetry and improves the experience of participants.

Objective:To explore latent class of symptoms related to psychological trauma and characteristics in patients with pregnancy loss, and to analyze the related influencing factors.Methods:From July 2022 to June 2024, a convenience sampling method was used to select 709 cases of pregnancy loss patients who visited the Maternity Department of the First Affiliated Hospital of Zhengzhou University as the survey subjects. The survey was conducted using the general information questionnaire, the post-traumatic stress disorder (PTSD) self-assessment scale, the hospital anxiety and depression scale, and the pittsburgh sleep index scale. Exploratory latent class analysis (LCA) of symptoms related to psychological trauma was performed by Mplus8.3, and then multivariate logistic regression was used to identify the factors influencing the latent classes.Results:A total of 691 patients with pregnancy loss were eventually investigated, with a total PTSD score of 24.00 (19.00, 33.00), a total anxiety score of 6.00 (3.00, 9.00), a total depression score of 6.00 (3.00, 9.00), and a total sleep disorder score of 7.00 (4.00, 9.00). Symptoms related to psychological trauma could be classified into 3 potential categories named high symptom group [20.4% (141/691)], anxiety-depression group [15.3% (106/691)] and low symptom group [64.3% (444/691)]. The result of multivariate logistic regression analysis showed that per capita monthly household income >8 000 yuan ( OR=0.477, 95% CI: 0.272-0.835, P=0.010) and having a spouse accompanying the patient at the time of admission ( OR=0.352, 95% CI: 0.234-0.532, P<0.001) were protective factors for the high symptom group, and gestational week≥28 weeks ( OR=3.192, 95% CI: 1.619-6.292, P=0.001) and assisted reproductive pregnancy ( OR=1.877, 95% CI: 1.075-3.277, P=0.027) were risk factors for the high symptom group. Conclusion:Symptoms associated with psychological trauma in patients with pregnancy loss have distinct categorical characteristics, and healthcare professionals should focus on patients with pregnancy loss in the high symptom group during hospitalization, and adopt targeted interventions according to the symptoms related to psychological trauma in different categories of patients with pregnancy loss in order to avoid serious psychological problems.

Objective:To investigate the efficacy of low-methoxyl pectin (LMP) combined with early enteral nutrition (EEN) in patients with severe acute pancreatitis (SAP) complicated by acute kidney injury (AKI).Methods:A prospective study was conducted, enrolling 85 patients with SAP complicated by AKI admitted to the First Hospital of Qinhuangdao from January 2022 to December 2023. These patients were randomized into an LMP group ( n=42) and a control group ( n=43) using a random number table. The control group received traditional EEN, while the LMP group received traditional EEN combined with LMP. Nutritional indicators [total protein (TP), albumin (Alb), and prealbumin (PA)], inflammatory markers [C-reactive protein (CRP), interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor-α (TNF-α)], renal function indicators [creatinine (Cr), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), uric acid (UA)], AKI stage, and fecal intestinal flora were compared between these two groups before and 7 days after intervention. Results:After 7 days of intervention, the TP, Alb, and PA levels significantly increased in both groups (all P<0.05); the increases in TP and PA were more significant in the LMP group (both P<0.05), whereas the increase in Alb did not differ significantly between groups ( P>0.05). The levels of CRP, IL-1, IL-6, IL-8, and TNF-α decreased significantly in both groups (all P<0.05),with more significant reductions in the LMP group (all P<0.001). The levels of Cr, eGFR, BUN, and UA improved significantly in both groups (all P<0.05),with more significant improvements in the LMP group (all P<0.05). The incidence of a higher AKI stage in the LMP group was significantly lower than that in the control group( P<0.05), and the incidence of a lower AKI stage was significantly higher than that in the control group ( P<0.001). The fecal counts of Bifidobacterium and Lactobacillus increased significantly while the fecal counts of Enterococcus and Enterobacter decreased significantly in both group (all P<0.001); notably, these changes in bacterial counts were significantly more pronounced in the LMP group ( P<0.001). Conclusions:EEN combined with LMP can significantly enhance nutritional status, reduce inflammatory response, and improve renal function in patients with SAP complicated by AKI.

Objective To investigate the application value of pan-immune-inflammation value(PIV),hypersensitive C-reactive protein(hs-CRP)/albumin(ALB)ratio(HCAR)and procalcitonin/platelet count ratio(PCT/PLT)in pulmonary infection in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 143 elderly patients with COPD and pulmonary bacterial infection were selected as the infected group.Meanwhile,143 elderly patients with COPD and without pulmonary infection were selected as the uninfected group.Patients in the infected group were furthrer divided into the mild group(47 cases),the moderate group(51 cases)and the severe group(45 cases)according to the degree of pulmonary infection.They were divided into the favorable prognosis group(112 cases)and the poor prognosis group(31 cases)according to the prognosis.Blood biochemical indicators,PIV,HCAR and PCT/PLT were compared between groups.The relationship between above indicators and pulmonary infection,infection degree and the prognosis was analyzed.Results Compared with the uninfected group,neutrophil(NEU),monocyte(MON),hs-CRP and PCT levels were higher,while lymphocyte(LYM)and ALB levels were lower in the infected group(P＜0.05).PIV,HCAR and PCT/PLT were higher in the infected group and the poor prognosis group than those in the uninfected group and the favorable prognosis group,respectively(P＜0.05).PIV,HCAR and PCT/PLT in the mild group,the moderate group and the severe group increased in sequence(P＜0.05).Spearman correlation analysis showed that PIV,HCAR and PCT/PLT were positively correlated with the degree of pulmonary infection(P＜0.05).Multivariate Logistic regression analysis showed that high levels of PIV,HCAR and PCT/PLT were independent risk factors for pulmonary infection in elderly patients with COPD(P＜0.05),and also independent risk factors for poor prognosis in patients with pulmonary infection(P＜0.05).The areas under the curve(AUC)of PIV combined with HCAR and PCT/PLT for diagnosing pulmonary infection in elderly patients with COPD and predicting poor prognosis in patients with pulmonary infection were 0.980 and 0.910(P＜0.05).Conclusion PIV,HCAR and PCT/PLT are related to COPD with pulmonary infection in the elderly.They can help to identify pulmonary infection,judge the condition of pulmonary infection and evaluate the prognosis in patients with pulmonary infection.