Objective To study the efficacy and safety of less invasive surfactant administration(LISA)combined with budesonide and supported by nasal intermittent positive pressure ventilation(NIPPV)in preterm infants with respiratory distress syndrome(RDS).Methods Premature infants with RDS at the gestational age of 26-32 weeks in the neonatal ward of Xuzhou Central Hospital from Feb-ruary 2022 to March 2024 were divided into the observation group and the control group in this prospective randomized controlled trial.The control group suspended nasal continuous positive airway pressure(NCPAP),they were intubated and infused with PS into the lung through endotracheal tube and extubated(INSURE),then continued to receive NCPAP.In the observation group,a LISA tube was insert-ed through the vocal cords under direct vision with direct laryngoscope,then infused pulmonary surfactant(PS)and budesonide into the lung when NIPPV ventilation was applied.The results of blood gas analysis at 1h and 6h after intratracheal instillation of PS,medication administration,clinical efficacy,related complications of budesonide,bronchopulmonary dysplasia(BPD)were compared between the two groups.Results A total of 126 preterm infants with RDS were enrolled in the study,including 65 in the observation group and 61 in the control group.The incidence of regurgitation in the observation group were lower than those in the control group[(10.8％(7/65)vs 24.6％(15/61)],and the differences were statistically significant(P＜0.05).The PaO2/FiO2(P/F)in the observation group at 1h and 6h were higher than those in the control group,while PaCO2were lower than those in the control group,and the differences were statis-tically significant(all P＜0.05).The duration of non-invasive respiratory support(11.4±4.6 days vs 15.9±5.6 days),total oxygen inhaling(14.9±6.9 days vs 21.2±8.5 days),failure rate of machine withdrawal[(10.8％(7/65)vs 24.6％(15/61)],the rate of tracheal intubation within 72h[9.2％(6/65)vs 23.0％(14/61)],and re-administration of PS[18.5％(12/65)vs 34.4％(21/61)],the times of apnea[9.0(3.0-25.0)times vs 17.0(5.0-29.0)times]in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05).The occurrence of BPD in the observational group were lower than those in the control group[15.4％(10/65)vs 34.4％(21/61)](P＜0.05).There were no significant differences between two groups in the related complications of budesonide(all P＞0.05).Conclusion LISA combined with budesonide and supported by NIPPV can effectively improve oxygenation,shorten the duration of non-invasive respiratory support,reduce the mechanical ventilation rate,and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26-32 weeks.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective To comprehensively understand the map of transcripts during mitosis and their regulatory mechanisms of HAP 1 cells by conducting transcriptome sequencing analysis after being released by mitotic synchro-nization arrest.Methods HAP1 cells were subjected to mitotic synchronous arrest with nocodazole and samples were collected after 0,20,80 min release,and RNA sequencing(RNA-seq)were performed.The transcriptome data was cleaned and the differentially expressed genes,expression trend clustering and functional enrichment com-bined with the protein interaction network were analyzed to explore the changes of signaling pathways in HAP 1 cells during mitosis.Results The transcriptome of HAP1 cells after synchronous release from mitosis underwent significant changes in time series,and differential gene cluster analysis revealed four gene clusters were enriched in important biological processes such as p53 signaling and cytoplasmic translation.Conclusions The transcriptome time-dependent dynamic changes during mitosis in HAP1 cells are coordinated regulation of key signaling pathways including cellular stress response,translational control and chromatin remodeling,ensuring a balance between growth and stress response upon mitotic exit.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective To study the efficacy and safety of less invasive surfactant administration(LISA)combined with budesonide and supported by nasal intermittent positive pressure ventilation(NIPPV)in preterm infants with respiratory distress syndrome(RDS).Methods Premature infants with RDS at the gestational age of 26-32 weeks in the neonatal ward of Xuzhou Central Hospital from Feb-ruary 2022 to March 2024 were divided into the observation group and the control group in this prospective randomized controlled trial.The control group suspended nasal continuous positive airway pressure(NCPAP),they were intubated and infused with PS into the lung through endotracheal tube and extubated(INSURE),then continued to receive NCPAP.In the observation group,a LISA tube was insert-ed through the vocal cords under direct vision with direct laryngoscope,then infused pulmonary surfactant(PS)and budesonide into the lung when NIPPV ventilation was applied.The results of blood gas analysis at 1h and 6h after intratracheal instillation of PS,medication administration,clinical efficacy,related complications of budesonide,bronchopulmonary dysplasia(BPD)were compared between the two groups.Results A total of 126 preterm infants with RDS were enrolled in the study,including 65 in the observation group and 61 in the control group.The incidence of regurgitation in the observation group were lower than those in the control group[(10.8％(7/65)vs 24.6％(15/61)],and the differences were statistically significant(P＜0.05).The PaO2/FiO2(P/F)in the observation group at 1h and 6h were higher than those in the control group,while PaCO2were lower than those in the control group,and the differences were statis-tically significant(all P＜0.05).The duration of non-invasive respiratory support(11.4±4.6 days vs 15.9±5.6 days),total oxygen inhaling(14.9±6.9 days vs 21.2±8.5 days),failure rate of machine withdrawal[(10.8％(7/65)vs 24.6％(15/61)],the rate of tracheal intubation within 72h[9.2％(6/65)vs 23.0％(14/61)],and re-administration of PS[18.5％(12/65)vs 34.4％(21/61)],the times of apnea[9.0(3.0-25.0)times vs 17.0(5.0-29.0)times]in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05).The occurrence of BPD in the observational group were lower than those in the control group[15.4％(10/65)vs 34.4％(21/61)](P＜0.05).There were no significant differences between two groups in the related complications of budesonide(all P＞0.05).Conclusion LISA combined with budesonide and supported by NIPPV can effectively improve oxygenation,shorten the duration of non-invasive respiratory support,reduce the mechanical ventilation rate,and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26-32 weeks.

ObjectiveTo predict the targets and signaling pathways of Si Junzitang and Tongxie Yaofang in treating ulcerative colitis （UC） following the concept of "same disease with different treatments" based on the network pharmacology and explore the underlying mechanisms. MethodThe differentially expressed genes （DEGs） of UC were extracted from GeoChip. The active components and corresponding potential targets of Si Junzitang and Tongxie Yaofang were collected from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP）. The regulatory networks of Si Junzitang and Tongxie Yaofang were constructed and the protein-protein interaction （PPI） network was plotted. The core genes were predicted， followed by enrichment analysis. The UC model was induced in mice by dextran sodium sulfate （DSS） solution. Mice were randomly divided into a normal group， a UC group， a Si Junzitang group， a Tongxie Yaofang group， and a mesalazine group. Drugs were administered continuously for 14 days. The disease activity index （DAI） was scored for mice in each group. The characteristic values of hemorheology were measured. The serum levels of interleukin-6 （IL-6）， tissue factor （TF）， and hypoxia-inducible factor-1α （HIF-1α） in mice were detected. The relative mRNA expression levels of inhibitory kappa B kinase α （IKKα）， nuclear factor kappa B （NF-κB）， HIF-1α， and vascular endothelial growth factor （VEGF） were measured. ResultA total of 44 genes were obtained by network pharmacological analysis， including 17 common genes. HIF-1 pathway and hypoxia response were potential common targets of Si Junzitang and Tongxie Yaofang in the treatment of UC. The results showed that Si Junzitang and Tongxie Yaofang could significantly reduce DAI score， increase blood perfusion volume and blood cell movement speed， decrease the concentration of mobile red blood cells， reduce the levels of IL-6， TF， and HIF-1α， down-regulate the mRNA expression of IKKα， NF-κB， HIF-1α， and VEGF. ConclusionThe HIF-1 pathway and related targets may be the common targets of Si Junzitang and Tongxie Yaofang to exert different therapeutic effects on the same disease. Si Junzitang is potent in promoting Qi circulation to improve intestinal tissue hypoxia， and Tongxie Yaofang is effective in promoting blood circulation to facilitate intestinal mucosal microcirculation.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Objective:To understand the rate of spirometry examination and its related factors among chronic obstructive pulmonary disease (COPD) patients aged ≥40 years in China from 2014 to 2015, and provide evidence for diagnosis, treatment and management of COPD patients normatively.Methods:Data were obtained from 2014-2015 COPD surveillance, China. The previous lung function examination status and other information of the subjects were collected by face-to-face survey. We defined COPD as a post-bronchodilator FEV 1: FVC less than 70%. A total of 9 130 COPD patients were included in the analysis of this study. The rate of spirometry examination and its 95% confidence interval ( CI) were estimated in COPD patients aged ≥40 years with complicated sampling weights. Meanwhile, the spirometry examination related factors were analyzed. Results:The estimated rate of spirometry examination among COPD patients was 5.9% (95% CI: 4.9%-6.9%), 6.1% (95% CI: 5.2%-7.1%) for men and 5.3% (95% CI: 4.0%-6.6%) for women. The rate was significantly higher in urban population than in rural ( P<0.001). With the increase of education level, the rate of spirometry examination among COPD patients increased gradually ( P<0.001). The rate of spirometry examination was 4.0% (95% CI: 3.1%-4.9%) among COPD patients in agricultural industry. The rate of spirometry examination among COPD patients with awareness of pulmonary function test was 32.3% (95% CI: 26.4%-38.1%). The rate of spirometry examination among COPD patients with previous chronic respiratory disease and respiratory symptoms were 13.7%(95% CI:11.5%-15.9%), 8.8%(95% CI:7.2%-10.4%), respectively. The rate of spirometry examination among COPD patients exposed to occupational dust and/or harmful gases was 5.7% (95% CI: 4.6%-6.9%). The rate of spirometry examination in former smokers among COPD patients was 10.2% (95% CI: 8.0%-12.4%), higher than those in current smokers (4.2%, 95% CI: 3.3%-5.1%) and non-smokers (6.3%, 95% CI: 5.1%-7.6%). Conclusion:The rate of spirometry examination is extremely low among COPD patients aged ≥40 in China, and the standardized diagnosis, treatment and management of COPD patients need to be improved urgently.

Objective:To understand the medication treatment rate and its associated factors among chronic obstructive pulmonary disease (COPD) patients aged ≥40 years in China, and to provide basic data for targeted interventions to improve the diagnosis and treatment of COPD patients.Methods:Data were from COPD surveillance of Chinese residents in 2014-2015. Questionnaire and pre-bronchodilator and post-bronchodilator spirometry were performed on all respondents. Individuals with post-bronchodilator FEV 1/FVC<70% were diagnosed as COPD patients. A total of 9 120 COPD patients were included in the analysis. Based on the complex sampling design, the medication treatment rate and 95% CI among COPD patients were estimated, and the associated factors were analyzed. Results:The medication treatment rate for COPD patients aged ≥40 years was 11.7% (95% CI: 10.2%-13.0%), the treatment rate with inhaled medication was 3.4% (95% CI: 2.9%-4.0%), and the treatment rate with oral or intravenous medication was 10.4% (95% CI: 9.0%-12.0%). All treatment rates were higher in patients who knew that they had COPD before the investigation. The rate of medication treatment in patients aged ≥60 years was higher than that in patients aged <60 years. Medication treatment rate, and oral or intravenous medication treatment rate among women were higher than those among men. These two treatment rates in patients with harmful occupational exposure were higher than those in patients without exposure. The medication treatment rate, and oral or intravenous medication treatment rate in former smokers were higher than those in current smokers and never smokers. Patients who knew that they had COPD before the investigation had higher rates of three treatments than those who were not aware of their disease conditions. Those with respiratory symptoms had higher three treatments rates than those without symptoms. Conclusion:In China, the rate of medication treatment for COPD patients aged ≥40 years old, especially the rate of inhaled medication treatment was very low. Being aware of their own COPD status and the emergence of respiratory symptoms were important factors associated with COPD medication treatment. Early diagnosis of COPD should be strengthened and the level of standardized treatment for patients should be improved.

Objective:To understand the smoking cessation behaviors in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention.Methods:COPD patients with post-bronchodilator FEV 1/FVC<70% were selected from COPD surveillance (2014-2015) of China, in which 5 791 current or former smokers defined by questionnaire survey were included in the study. The smoking cessation rate/ratio and the successful smoking cessation rate in COPD patients, the successful smoking cessation rate in COPD patients who ever smoked daily and the rate of attempting to quit smoking in current smokers with COPD were estimated using data adjusted by complicated sampling method. Results:The smoking cessation rate was 25.0% and the successful smoking cessation rate was 19.1% in COPD patients aged 40 years or older who ever smoked. The smoking cessation ratio was 23.1% and the successful smoking cessation ratio was 17.6% in COPD patients who ever smoked daily. The rate and ratio were higher in urban area than rural area ( P<0.05) and increased with age ( P<0.05). Patients who were aware of smoking being a risk factor for COPD had higher rate and ratio than patients who were not aware ( P<0.05). Patients with more severe airflow limitation and patients smoking less had higher rate and ratio ( P<0.05). Conclusions:The smoking cessation rate and ratio were low in COPD patients in China. More health education for COPD patients about smoking cessation needs to be strengthened. It is suggested for healthcare workers to actively advise smoking cessation and suggest smoking cessation ways for patients who smoke in their routine clinical service to increase the successful smoking cessation rate/ratio in COPD patients.