Objective To employ three dimensional high-resolution vessel wall magnetic resonance imaging(3D hr-VW-MRI)for analyzing the imaging characteristics of posterior circulation non-stenotic intracranial atherosclerotic plaque and to discuss its diagnostic value in identifying culprit plaques.Methods Ninety-three patients(age[62.94±9.70]years old,67 males,26 females)with non-stenotic atherosclerosis in our hospital from Jan.2019 to Jan.2021 were retrospectively recruited.The imaging features of plaques,including luminal area,maximum wall thickness and minimum wall thickness at the most stenotic site,stenosis rate,plaque burden,remodeling index,eccentricity index,enhancement ratio at the most stenotic site,and intraplaque hemorrhage,were measured based on T1-weighted imaging(T1WI)and contrast-enhanced T1WI.The culprit plaque was defined as a lesion arising from the responsible vascular supply area to a fresh infarction on the diffusion weighted imaging(DWI)and T2 fluid attenuated inversion recovery(T2-FLAIR)images with accompanying ischemic stroke/transient ischemic attack(TIA).A plaque was considered to be a nonculprit plaque when it occurred in patients with presumed ischemic stroke/TIA,but without an infarct on DWI and T2-FLAIR.Results Sixty-one culprit plaques and 32 non-culprit plaques were analyzed.The proportions of patients with hyperlipidemia,National Institutes of Health stroke scale(NIHSS)score,narrowest plaque enhancement rate,and incidence of intraplaque hemorrhage in the culprit plaque group were significantly higher than those in the non-culprit plaque group(all P＜0.05).Multivariate logistic regression analyses showed that NIHSS score(odds ratio[OR]=1.799,95％confidence interval[CI]1.303-2.484,P＜0.001),enhancement ratio(OR=1.076,95％CI 1.027-1.128,P=0.002)and intraplaque hemorrhage(OR=30.708,95％CI 2.563-367.925,P=0.007)were associated with plaque type.Conclusion NIHSS score,enhancement ratio at the most stenotic site,and intraplaque hemorrhage are independent risk factors for culprit plaques in patients with posterior circulation non-stenotic intracranial atherosclerotic disease.These indicators may help identify such culprit plaques and could be used to screen individuals with plaques having these characteristics,thereby providing a basis for early preventive interventions.

Objective To investigate the mechanism of Dayuan Decoction in the treatment of Helicobacter pylori(Hp)-positive perioral acne based on network pharmacology and animal experiments.Methods The effective active components and their corresponding targets of Dayuan Decoction were obtained from TCMSP.Targets related to Hp and perioral acne were retrieved from GeneCards,OMIM and TTD databases,and the intersection of drug targets and disease targets was considered as the target of Dayuan Decoction in the treatment of Hp-positive perioral acne.A protein-protein interaction network for the drug-disease intersection targets was constructed by using Cytoscape 3.7.2 and the STRING database,and the core targets were screened.GO and KEGG pathway enrichment analyses of the core target genes were performed using the DAVID database and the bioinformatics platform.By establishing an Hp-positive perioral acne rat model through gastric gavage with Hp bacterial liquid and intradermal injection of Propionibacterium acnes suspension,the intervention effect of Dayuan Decoction was observed and the core targets and related pathways were preliminary validated.Morphology in the perioral skin and gastric tissue were observed through HE staining.The expressions of TLR4,MyD88,NF-κB in perioral skin tissue,the contents of TNF-α and IL-6 in serum were measured using ELISA.Results A total of 145 active components were screened from Dayuan Decoction,corresponding to 253 targets,with 57 targets overlapping between drugs and diseases.The core targets for the treatment of Hp-positive perioral acne with Dayuan Decoction were identified as IL6,TNF,IL1B,AKT1,TP53,etc.KEGG pathway enrichment analysis revealed 153 signaling pathways,primarily involved in pathways in cancer,lipids and atherosclerosis,AGE-RAGE signaling pathway in diabetic complications,TLR signaling pathway and TNF signaling pathway.Dayuan Decoction attenuated the expression of TLR4,MyD88 and NF-κB in the perioral skin of the Hp-positive perioral acne rat model,as well as reduced the contents of TNF-α and IL-6 in serum(P<0.01).Conclusion Dayuan Decoction may exert therapeutic effects on Hp-positive perioral acne by modulating the TLR4/NF-κB signaling pathway,reducing the levels of inflammatory factors TNF-α and IL-6,and alleviating the inflammatory damage in the perioral skin.

Objective To explore the mechanism of Dayuan Decoction in treating Helicobacter pylori(Hp)positive oral ulcer based on network pharmacology and experimental validation.Methods Active components of Dayuan Decoction and its targets were collected using the TCMSP database;relevant targets for Hp positive oral ulcer were screened through the GeneCards database;the Venny 2.1.0 online platform was used to screen the intersection targets of drug active components and diseases;a protein-protein interaction network was built using STRING 11.0 database and core key targets were screened using Cytoscape 3.7.1 software;GO and KEGG enrichment analysis was conducted on intersection targets using the DAVID database.Oral administration of standard Hp bacterial solution and burning of oral mucosa with glacial acetic acid were used to construct an animal model of Hp positive oral ulcer,and the model rats were intervented with Dayuan Decoction by gavage.The morphology of oral and gastric mucosal tissues was observed,and the expression of core targets in oral and gastric mucosal tissues were detected.Results A total of 165 targets were obtained for the treatment of Hp positive oral ulcer with Dayuan Decoction.The main active components were quercetin,kaempferol,5,8,2'-trihydroxy-7-methoxyflavone,etc.,the core targets were AKT1,IL6,TP53,TNF,etc.GO and KEGG enrichment analysis suggested that Dayuan Decoction in the treatment of Hp positive oral ulcer was mainly related to the inflammatory pathway.Animal experiments showed that compared with the blank group,the structure of the oral and gastric tissues in the model group rats were significantly disrupted,with significant infiltration of inflammatory cells;the contents of IL-6 and TNF-α in the serum significantly increased(P<0.05),the contents of TLR4 and NLRP3 in oral and gastric mucosal tissues significantly increased(P<0.05),and the protein expression of TLR4 and NF-κB in oral mucosal tissues significantly increased(P<0.05).Compared with the model group,the histopathological manifestations of rats in all doseage of Dayuan Decoction groups significantly improved,the contents of IL-6 and TNF-α in the serum,and the contents of TLR4 and NLRP3 in the oral and gastric mucosal tissues significantly decreased,the protein expression of TLR4 and NF-κB in the oral mucosal tissue significantly decreased(P<0.05).Conclusion Dayuan Decoction is possible to regulate the inflammatory development of Hp positive oral ulcer and improve their symptoms by downregulating TLR4 and NF-κB levels.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective Gallstone disease(GSD)is one of the common digestive tract diseases with a high worldwide prevalence.The effects of GSD on patients include but are not limited to the symptoms of nausea,vomiting,and biliary colic directly caused by GSD.In addition,there is mounting evidence from cohort studies connecting GSD to other conditions,such as cardiovascular diseases,biliary tract cancer,and colorectal cancer.Early identification of patients at a high risk of GSD may help improve the prevention and control of the disease.A series of studies have attempted to establish prediction models for GSD,but these models could not be fully applied in the general population due to incomplete prediction factors,small sample sizes,and limitations in external validation.It is crucial to design a universally applicable GSD risk prediction model for the general population and to take individualized intervention measures to prevent the occurrence of GSD.This study aims to conduct a multicenter investigation involving more than 90 000 people to construct and validate a complete and simplified GSD risk prediction model.Methods A total of 123 634 participants were included in the study between January 2015 and December 2020,of whom 43 929 were from the First Affiliated Hospital of Chongqing Medical University(Chongqing,China),11 907 were from the First People's Hospital of Jining City(Shandong,China),1 538 were from the Tianjin Medical University Cancer Institute and Hospital(Tianjin,China),and 66 260 were from the People's Hospital of Kaizhou District(Chongqing,China).After excluding patients with incomplete clinical medical data,35 976 patients from the First Affiliated Hospital of Chongqing Medical University were divided into a training data set(n=28 781,80% )and a validation data set(n=7 195,20% ).Logistic regression analyses were performed to investigate the relevant risk factors of GSD,and a complete risk prediction model was constructed.Factors with high scores,mainly according to the nomograms of the complete model,were retained to simplify the model.In the validation data set,the diagnostic accuracy and clinical performance of these models were validated using the calibration curve,area under the curve(AUC)of the receiver operating characteristic curve,and decision curve analysis(DCA).Moreover,the diagnostic accuracy of these two models was validated in three other hospitals.Finally,we established an online website for using the prediction model(The complete model is accessible at https://wenqianyu.shinyapps.io/Completemodel/,while the simplified model is accessible at https://wenqianyu.shinyapps.io/Simplified/).Results After excluding patients with incomplete clinical medical data,a total of 96 426 participants were finally included in this study(35 876 from the First Affiliated Hospital of the Chongqing Medical University,9 289 from the First People's Hospital of Jining City,1 522 from the Tianjin Medical University Cancer Institute,and 49 639 from the People's Hospital of Kaizhou District).Female sex,advanced age,higher body mass index,fasting plasma glucose,uric acid,total bilirubin,gamma-glutamyl transpeptidase,and fatty liver disease were positively associated with risks for GSD.Furthermore,gallbladder polyps,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and aspartate aminotransferase were negatively correlated to risks for GSD.According to the nomograms of the complete model,a simplified model including sex,age,body mass index,gallbladder polyps,and fatty liver disease was constructed.All the calibration curves exhibited good consistency between the predicted and observed probabilities.In addition,DCA indicated that both the complete model and the simplified model showed better net benefits than treat-all and treat-none.Based on the calibration plots,DCA,and AUCs of the complete model(AUC in the internal validation data set=74.1%[95% CI:72.9%-75.3%],AUC in Shandong=71.7%[95% CI:70.6%-72.8%],AUC in Tianjin=75.3%[95% CI:72.7%-77.9%],and AUC in Kaizhou=72.9%[95% CI:72.5%-73.3%])and the simplified model(AUC in the internal validation data set=73.7%[95% CI:72.5%-75.0%],AUC in Shandong=71.5%[95% CI:70.4%-72.5%],AUC in Tianjin=75.4%[95% CI:72.9%-78.0%],and AUC in Kaizhou=72.4%[95% CI:72.0%-72.8%]),we concluded that the complete and simplified risk prediction models for GSD exhibited excellent performance.Moreover,we detected no significant differences between the performance of the two models(P>0.05).We also established two online websites based on the results of this study for GSD risk prediction.Conclusions This study innovatively used the data from 96 426 patients from four hospitals to establish a GSD risk prediction model and to perform risk prediction analyses of internal and external validation data sets in four cohorts.A simplified model of GSD risk prediction,which included the variables of sex,age,body mass index,gallbladder polyps,and fatty liver disease,also exhibited good discrimination and clinical performance.Nonetheless,further studies are needed to explore the role of low-density lipoprotein cholesterol and aspartate aminotransferase in gallstone formation.Although the validation results of the complete model were better than those of the simplified model to a certain extent,the difference was not significant even in large samples.Compared with the complete model,the simplified model uses fewer variables and yields similar prediction and clinical impact.Hence,we recommend the application of the simplified model to improve the efficiency of screening high-risk groups in practice.The use of the simplified model is conducive to enhancing the self-awareness of prevention and control in the general population and early intervention for GSD.

OBJECTIVE To provide references for the clinical safe use of axitinib. METHODS Adverse drug event （ADE） data for axitinib were collected from the US FDA Adverse Event Reporting System （FAERS） database from the first quarter of 2012 to the fourth quarter of 2022. The data were mined and analyzed by utilizing the ratio-of-reporting-ratio （ROR） method and comprehensive standard method of the United Kingdom’s Medicines and Healthcare Products Regulatory Agency （MHRA） of proportional imbalance measurement. RESULTS A total of 13 962 reports of axitinib-related ADEs were obtained， with patients’ age concentrated in 65-85 years （43.25%）， gender predominantly male （65.23%）， country of reporting predominantly US （60.01%）， and serious ADE outcomes mostly hospitalization or prolonged hospitalization （31.51%）. A total of 172 ADE risk signals were detected， involving 18 system and organ classifications （SOC）， mainly systemic diseases and various reactions at the site of administration （3 749 cases， 30.84%） and gastrointestinal system diseases （2 067 cases， 17.00%）. ADE risk signals that occurred more frequently were generally consistent with the drug instruction， such as diarrhea， fatigue， and hypertension； new ADE risk signals requiring clinical attention were death， immune-mediated nephritis， and PT signals contained in the SOC of various benign， malignant， and tumors of undetermined nature （including cysts and polyps）. CONCLUSIONS For ADEs that occur frequently with axitinib and are already contained in the drug instruction （e.g. hypertension， diarrhea）， they should be adequately evaluated before administration， especially for patients with combined use of immune checkpoint inhibitors and patients with underlying hypertension； for ADEs with stronger signals and newer ADEs （e. g. death， disease progression， tumor progression）， the patient’s disease progression should be closely monitored during the treatment period for potentially fatal ADEs； for its rare ADEs （e. g.immune-mediated nephritis， scrotal ulcer， non-infectious encephalitis）， clinical validation should be further strengthened.

Objective: To observe the effects of electroacupuncture (EA) at Neiguan (PC6) on arrhythmia during acute myocardial ischemia-reperfusion and the expression of connexin 43 (Cx43) in rats. Methods: A total of 40 Sprague-Dawley male rats were used. Ten rats were randomly selected as the blank group, and the remaining 30 rats were randomly divided into a model group and an EA group, with 15 rats in each group. Before modeling, rats in the EA group received one session of EA intervention at bilateral Neiguan (PC6) for 30 min; the other groups were treated with the same grasping and anesthesia for 30 min without intervention. PowerLab physiological recorder was used to record electrocardiograph within 30 min of infarction. After the experiment, cardiac tissue and serum were collected from rats. Hematoxylin-eosin (HE) staining was used to observe the morphological changes of myocardial tissue in the ventricular infarction area of rats in each group. The expression of Cx43 protein in the myocardium of each group was detected by Western blotting (WB). Enzyme-linked immunosorbent assay (ELISA) was used to determine the activity of Na+-K+-ATPase in myocardial tissue and the serum content of endogenous digitalis-like factor (EDLF) in rats. Results: There was no statistical difference in arrhythmia score between the EA group and the model group, but the total duration and average duration of arrhythmia in the EA group were decreased (P<0.01). HE staining showed that compared with the blank group, myocardial cells in the model group were disorganized and seriously damaged. The pathological changes in the EA group were similar to those in the model group, but the damage was relatively minor. The results of WB showed that compared with the blank group, the Cx43 expression in myocardial tissue of the model group was decreased (P<0.01); compared with the model group, the Cx43 expression in the EA group was increased (P<0.01); compared with the blank group, the Na+-K+-ATPase activity in myocardial tissue of the model group was significantly decreased (P<0.01); compared with the model group, the Na+-K+-ATPase activity in the EA group was increased (P<0.01). ELISA results showed that compared with the blank group, the serum EDLF content in the model group was significantly increased (P<0.01); compared with the model group, the EDLF content in the EA group was decreased (P<0.01). Conclusion: EA at Neiguan (PC6) can delay and reduce the onset of arrhythmia during myocardial infarction in the rat model of myocardial ischemia-reperfusion. Its mechanism of action may be related to the regulation of the Cx43 expression in myocardial tissue, improvement of the activity of Na+-K+-ATPase in myocardial tissue, and increase in the content of serum EDLF.

Objective To observe the expression of tyrosine kinase 2(JAK2)and signal transducer and activator of transcription 3(STAT3)in myocardial tissue of rats with myocardial ischemia-reperfusion injury(MIRI)by electroacupuncture at"Neiguan"point,and explore the mechanism of electroacupuncture in up regulating JAK2/STAT3 signal pathway,promoting the expression of anti-inflammatory factors,and reducing MIRI injury.Methods Thirty male SD rats with normal echocardiography were randomly divided into sham operation group,model group and electroacupuncture group,with 10 rats in each group.MIRI models were prepared by ligation of left anterior descending coronary artery(LAD)in model group and electroacupuncture group,while in sham operation group,only threading was performed without ligation.In the electroacupuncture group,electroacupuncture(density wave,2 Hz/100 Hz,2 mA)at bilateral"Neiguan"points was performed on the 1st,3rd and 5th days after the modeling operation,once a day,20 minutes each time.The left ventricular ejection fraction(LVEF)of rats on the 1st,3rd and 5th day after operation was observed by echocardiography to evaluate cardiac function;HE staining was used to observe the pathological changes of rat myocardium;The myocardial fibrosis was observed by Masson staining;The expression of IL-4 and IL-6 in myocardium was detected by ELISA;The expressions of IL-1β and IL-10 in myocardial tissue were detected by immunohistochemistry;The expression of JAK2,p-JAK2,STAT3,p-STAT3 protein in myocardial infarction area was measured by Western blot.Results Compared with sham operation group,EF in model group decreased significantly(P<0.05),fibrosis area increased(P<0.05),IL-4,IL-6,IL-10,IL-1β The content of JAK2,p-JAK2,STAT3,p-STAT3 protein increased(P<0.05);Compared with the model group,the EF of rats in the electroacupuncture group increased(P<0.05),the fibrotic area of rats in the electroacupuncture group decreased(P<0.05),the content of IL-4 and IL-10 increased,and IL-6 and IL-1β The expression of JAK2,p-JAK2,STAT3,p-STAT3 protein increased(P<0.05).Conclusion Electroacupuncture at Neiguan point can significantly up regulate JAK2/STAT3 signal pathway,reduce the secretion of proinflammatory factors,increase the expression of anti-inflammatory factors,and alleviate myocardial ischemia reperfusion injury in rats.

Objective:To combine micro-course and flipped classroom, integrate the application of online WeChat group and teaching video, build a new teaching framework, and seek the application of flipped classroom based on "micro-course" in clinical skills training of general anesthesia and tracheal intubation for medical students.Methods:A total of 82 clinical medicine intern students of Batch 2015 and 2016 from Nnajing Drum Tower Hospital were selected as the research subjects to complete the internship (for two weeks). The teaching reform group (44 people) adopted the flipped classroom based on "micro-course"; the traditional group (38 people) adopted traditional teaching. Organized by the undergraduate teaching and research department, the number of tracheal intubation cases and the number of excellent scores were recorded during the two-week internship in anesthesia. After the rotation, a questionnaire survey was conducted to evaluate the mastery of endotracheal intubation operation and satisfaction with the teaching and training arranged by the department. SPSS 23.0 was used to conduct t test and non-parametric test. Results:The number of outstanding cases of tracheal intubation in the teaching reform group was higher than that in the traditional group, and the number of outstanding cases of tracheal intubation in girls was higher than that in boys, and the difference was statistically significant ( P<0.05). The self-assessed scores of the students' mastery of tracheal intubation and the satisfaction with clinical practice training in the teaching reform group were higher than those in the traditional group, and the difference was statistically significant ( P<0.05). Conclusion:Compared with traditional teaching, the flipped classroom based on "micro-course" has more advantages in the clinical skills training of medical tracheal intubation.

With continuous discovery of tumor immune targets and continuous changes in antibody research and development technology, antibody drugs are becoming more and more widely used in clinical practice. However, some targets are not only expressed on tumor cells, but also on red blood cells. Therefore, the clinical application of antibodies against the corresponding targets may interfere with the detection of blood transfusion compatibility, resulting in difficulty in blood matching or delay of blood transfusion. This consensus summarizes the current solutions for the interference of CD38 monoclonal antibody (CD38 mAb) in transfusion compatibility testing. After analyzing the advantages and disadvantages of different methods, polybrene and sulfhydryl reducing agents [dithiothreitol (DTT) or 2-mercaptoethanol (2-Me)], as a solution for CD38 mAb interference in blood compatibility testing, are recommended for Chinese patients, so as to eliminate blood transfusion interference produce by CD38 mAb and further provide a pre-transfusion workflow for clinicians and technicians in Department of Blood Transfusion.