The prescription of Qidong Yixin oral liquid is derived from the experience of national medical master Ren Jixue in treating viral myocarditis （VMC）. It has the functions of tonifying Qi， nourishing the heart，calming the mind， and relieving palpitations. It is used to treat VMC and angina pectoris of coronary heart disease caused by deficiency of both Qi and Yin. However，the understanding of its efficacy evidence， advantageous aspects， dosage and administration， and medication safety remains insufficient in clinical practice. Therefore，the development of the Expert Consensus on the Clinical Application of Qidong Yixin Oral Liquid （hereinafter referred to as consensus） was initiated. Consensus strictly followed the process and methods of the expert consensus on the clinical application of Chinese patent medicines of the China Association of Chinese Medicine，successively completing multiple tasks such as the consensus project initiation，determination of clinical problems，evidence search and evaluation，formation of recommendation opinions and consensus suggestions，solicitation of opinions，peer review， submission for review and release， and so on. Consensus formed a total of 10 recommendation opinions and 12 consensus suggestions，clarifying the clinical positioning，efficacy advantages，syndrome differentiation，dosage and administration，combination therapy，timing of medication，adverse reactions，contraindications， and precautions of Qidong Yixin oral liquid，indicating that it has good clinical advantages and safety in the treatment of VMC and angina pectoris of coronary heart disease，providing norms and references for physicians to safely and rationally apply Qidong Yixin oral liquid. Consensus was reviewed and approved for release by the Standardization Office of the China Association of Chinese Medicine on December 23， 2024. Standard number：GSCACM-376-2024.

ObjectiveIn nature, objects cast shadows due to illumination, forming the basis for stereoscopic perception. Birds need to adapt to changes in lighting (meaning they can recognize stereoscopic shapes even when shadows look different) to accurately perceive different three-dimensional forms. However, how neurons in the key visual brain area in birds handle these lighting changes remains largely unreported. In this study, pigeons (Columba livia) were used as subjects to investigate how neurons in pigeon’s ventrolateral mesopallium (MVL) represent stereoscopic shapes consistently, regardless of changes in lighting. MethodsVisual cognitive training combined with neuronal recording was employed. Pigeons were first trained to discriminate different stereoscopic shapes (concave/convex). We then tested whether and how light luminance angle and surface appearance of the stereoscopic shapes affect their recognition accuracy, and further verify whether the results rely on specify luminance color. Simultaneously, neuronal firing activity of neurons was recorded with multiple electrode array implanted from the MVL during the presentation of difference shapes. The response was finally analyzed how selectively they responded to different stereoscopic shapes and whether their selectivity was affected by the changes of luminance condition (like lighting angle) or surface look. Support vector machine (SVM) models were trained on neuronal population responses recorded under one condition (light luminance angle of 45°) and used to decode responses under other conditions (light luminance angle of 135°, 225°, 315°) to verify the invariance of responses to different luminance conditions. ResultsBehavioral results from 6 pigeons consistently showed that the pigeons could reliably identify the core 3D shape (over 80% accuracy), and this ability wasn’t affected by changes in light angle or surface appearance. Statistical analysis of 88 recorded neurons from 6 pigeons revealed that 83% (73/88) showed strong selectivity for specific 3D shapes (selectivity index>0.3), and responses to convex shapes were consistently stronger than to concave shapes. These shape-selective responses remained stable across changes in light angle and surface appearance. Neural patterns were consistent under both blue and orange lighting. The decoding accuracy achieves above 70%, suggesting stable responses under different conditions (e.g., different lighting angles or surface appearance). ConclusionNeurons in the pigeon MVL maintain a consistent neural encoding pattern for different stereoscopic shapes, unaffected by illumination or surface appearance. This ensures stable object recognition by pigeons in changing visual environments. Our findings provide new physiological evidence for understanding how birds achieve stable perception (“invariant neural representations”) while coping with variations in the visual field.

Objective To investigate the protective effect and mechanism of adenosine-lidocaine-magnesium sulfate(ALM)resuscita-tion solution against acute lung injury in sepsis were investigated through in vitro and in vivo experiments.Methods ALM resuscitation solution effects on septic lung injury were assessed in SD rats and rat pulmonary micro vascular endothelial cells(PMVEC)in vitro,and the effector mechanism was explored by using network pharmacology combined with molecular biology methods,detecting alterations in nuclear factor kappaB(NF-κB)signaling pathway and inflammatory cytokine key protein expressions.Results Based on in vivo experi-ments,ALM resuscitation solution treatment significantly improved lung histopathological injury in cecal ligation and puncture(CLP)model rats,reduced the lung injury score and lung dry-to-wet ratio(P＜0.01),and significantly suppressed pro-inflammatory cytokine expressions such as that of IL-1β,IL-6,and TNF-α(P＜0.01).Moreover,in vitro experiments confirmed that ALM resuscitation solution significantly reduced p-p65 and p-IκBα protein expressions in LPS-induced PMVEC(P＜0.05),while down-regulating IL-1β,IL-6,and TNF-α protein levels(P＜0.01).Conclusion ALM resuscitation solution exerts a protective effect against acute lung injury in sepsis by inhibiting NF-κB signaling pathway activation and reducing pro-inflammatory cytokine release.

Objective:To explore the expression of filaggrin(FLG)in melanoma tissues and its correlation with clinicopathological features and prognosis in patients.Methods:A total of 70 melanoma patients treated at the People's Hospital Affiliated to Shandong First Medical University from June 2019 to August 2020 were selected as research subjects.Tumor tissues and adjacent tissues obtained during surgery were examined for FLG expression using immunohistochemistry.Based on FLG expression,patients were divided into a positive group and a negative group.The positive expression rates of FLG in tumor tissues,adjacent tissues and melanoma tissues with different pathological features were compared.The patients were followed up for 3 years,and based on prognosis,they were divided into a survival group(n=43)and a death group(n=27).The FLG positive expression rates were compared between the two groups.Kaplan-Meier survival curves were plotted,and survival times were compared.Results:The positive FLG expression rate in melanoma tissues was significantly lower than that in adjacent tissues(P<0.05).The proportions of patients with tumor diameter>1 cm,Breslow thickness>2 mm,local ulcer,TNM stage Ⅲ-Ⅳ,lymph node metastasis,and tumor invasion in positive FLG expression group were significantly lower than those in negative group(P<0.05 or P<0.01).Among the 70 patients,27 cases died and 43 survived,with a survival rate of 61.42%.The positive FLG expression rate was significantly lower in death group than that in survival group(P<0.05).The survival time of FLG-positive patients was significantly longer than that of FLG-negative patients(P=0.010).Multivariate Cox regression analysis revealed that Breslow thickness>2 mm,TNM grade Ⅲ-Ⅳ,lymph node metastasis,and tumor invasion were risk factors for the prognosis of melanoma patients(P<0.01 or P<0.001),while positive FLG expression was a protective factor(P<0.01 or P<0.001).Conclusion:FLG expression is significantly decreased in melanoma tissues and is associated with pathological features such as Breslow thickness,tumor stage,invasion,lymph node metastasis,and prognosis.

Objective:To investigate the effect of a blended teaching mode based on medical knowledge graph and artificial intelligence (AI) teaching assistant on students' learning effectiveness and systematic thinking ability in teaching of pathogens and immunology.Methods:A controlled experimental design was employed, involving 114 clinical medical students ("5+3" integrated) enrolled in 2023 at Tianjin Medical University. They were divided into experimental group ( n=57) and control group ( n=57) based on their classes. A blended online-offline teaching mode based on medical knowledge graph and AI teaching assistant was used in the experimental group, and a blended online-offline teaching mode based on the online resources of this course was used in control group. Teaching effectiveness was assessed by comparing the scores of four chapter quizzes and the final exam between the two groups, as well as by analyzing student questionnaire responses. Data were analyzed using t test and χ2 test. Results:The experimental group achieved significantly higher scores in all four chapter quizzes and the final exam compared to the control group [(78.77±19.65) vs. (69.47±22.95), (84.56±14.02) vs. (76.49±16.20), (81.89±13.60) vs. (73.13±16.52), (81.56±21.28) vs. (73.16±16.27), (69.75±13.30) vs. (64.10±14.93), all P<0.05]. The questionnaire survey showed that 74.07% students ( n=40) believed that this blended teaching model stimulated their learning interest, 74.07% ( n=40) students believed that this blended teaching model enhanced their learning initiative, 81.48% ( n=44) students believed that this blended teaching model could help them construct the relationship between the old and new knowledge and thus improved memory retention, and 81.48% students b( n=44) elieved that this blended teaching model helped them integrate and summarize knowledge and construct systematic knowledge framework to improve their learning effectiveness. Conclusions:The blended teaching mode based on medical knowledge graph and AI teaching assistant is beneficial for cultivating students' systematic thinking ability and is helpful to improve their learning efficiency and effectiveness.

Objective To investigate the effect and safety of esketamine combined with general anesthesia and ultrasound-guided cervical plexus block in axillary endoscopic thyroidectomy.Methods The subjects of this study,112 female patients who underwent axillary endoscopic thyroidectomy in our hospital from January 2022 to October 2024,were randomly divided into an observation group and a control group,each with 56 cases.All patients were administered with ultrasound-guided cervical plexus block followed by general anesthesia.The observation group was injected with 0.1 mg/kg of esketamine prior to anesthesia induction and continuously pumped with esketamine at a rate of 0.1 mg/(kg·h)during the operation until sutures were completed,while the control group was administered with an equal volume of normal saline following the same procedure.The vital sign indicators[mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO2)]immediately after establishing electrocardiogram monitoring(T0),immediately before tracheal intubation(T1),immediately after tracheal intubation(T2),immediately after skin incision(T3)and immediately after the operation(T4)were compared between the two groups.Surgical related indicators such as propofol dosage,remifentanil dosage,and extubation time were also compared between them.Pain visual analogue scale(VAS)scores were performed on patients from the two groups at 1,6,12,and 24 h postoperatively.The 40-item quality of recovery score(QoR-40)was used before the surgeries and 1 d after surgeries to assess the patients.Adverse reactions were also compared.Results The difference was significant in terms of MAP,HR time effect in the two groups(F=24.63,F=20.11,P<0.05)and inter-group MAP,HR values(F=13.54,F=11.49,P<0.05).There were statistically significant differences in the interaction effects of MAP and HR between the two groups(F=4.10,F=3.46,P<0.05).The difference was not statistically significant in time,inter group,and interaction effects of SpO2(P>0.05).The dosage of propofol,remifentanil,and postoperative 1 d drainage in the observation group were less than those in the control group,the differences were statistically significant(P<0.05).The differences were not statistically signiciant in extubation time and awakening time between the two groups(P>0.05).The VAS scores at 1,6,12,and 24 h after operation in the observation groups were lower than those in the control group,the differences were statistically significant(P<0.05).Physical comfort,pain dimension ratings,and total score of the QoR-40 scale:1)those 1 d after operation were lower than those before operation in both groups(P<0.05);2)1 d after operation:those in the control group were lower than those in the observation group(P<0.05).The control group witnessed a remarkable decrease in QoR-40 emotional state rating 1 d after operation than it did before operation(P<0.05),while no significant change was seen by the observation group in this regard(P>0.05).The incidence of coughing after extubation in the observation group was lower than that in the control group(14.29%and 37.50%),the difference was statistically significant(P<0.05).The differences were not statistically signiciant in the incidence of other adverse reactions such as nausea,vomiting,dizziness,headache,respiratory depression,awakening restlessness and awakening delirium between the two groups(P>0.05).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(25.00%and 66.07%,P<0.05).Conclusion The application of esketamine combined with general anesthesia and ultrasound-guided cervical plexus block in axillary endoscopic thyroidectomy can significantly stabilize hemodynamics in patients,reduce postoperative pain,and promote postoperative recovery.It is worthy clinical application.

Objective To explore the diagnostic value of serum C-reactive protein(CRP),serum amyloid A(SAA)and procalcitonin(PCT)combined with lactate dehydrogenase(LDH)and adenosine deaminase(ADA)in cerebrospinal fluid for elderly patients with central nervous system infection and their differential significance for different infection types.Methods A total of 97 elderly patients with central nervous system infection were enrolled as the infection group,including 31 cases with tuberculous meningitis(tuberculous meningitis group),36 cases with suppurative meningitis(suppurative meningitis group)and 30 cases with viral meningitis(viral meningitis group).A total of 97 patients with normal laboratory examination indexes who were treated due to primary headache during the same period were enrolled as the control group.The samples of fasting elbow venous blood were collected in the early morning of the next day after admission,and the serum was isolated to detect CRP and SAA levels.When consultation,lumbar puncture was performed to collect cerebrospinal fluid for the detection of LDH and ADA levels.The differences in above indexes were compared between groups,and diagnostic efficiency of each index and combined detection for central nervous system infection in elderly was analyzed by receiver operating characteristic(ROC)curves.Results The serum levels of CRP,SAA and PCT,and LDH and ADA in cerebrospinal fluid were higher in the infection group than those in the control group(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)values of serum CRP,SAA and PCT,and cerebrospinal fluid LDH and ADA,and combined detection in the diagnosis of central nervous system infection were all>0.70(P＜0.05),showing good predictive efficiency and diagnostic efficiency,and the diagnostic efficacy of combined detection was the best.The cut-off values of serum CRP,SAA and PCT,cerebrospinal fluid LDH and ADA were 6.32 mg/L,33.86 mg/L,2.81 μg/L,33.53 U/L and 1.99 U/L,respectively.The serum levels of CRP,SAA and PCT were the highest in the suppurative meningitis group,while which were the lowest in the viral meningitis group.The cerebrospinal fluid levels of LDH and ADA were the highest in the tuberculous meningitis group,while which were the lowest in the viral meningitis group(P＜0.05).Conclusion The combined detection of serum CRP,SAA and cerebrospinal fluid PCT and LDH has certain diagnostic value for elderly central nervous system infection,which is beneficial to identify infection types.

Objective:By combining image memory with educational games, electrocardiogram (ECG) images were integrated with card games to simplify complex ECG knowledge and visualize abstract concepts. This approach stimulated students' motivation to learn within the game, thereby enhancing their cognitive abilities and aiding them in mastering ECG-related knowledge.Methods:Through literature search and brainstorming, ECG learning flash cards and game process were designed. Using the convenience sampling method, 55 medical students from a university were selected to conduct the self-designed questionnaire before and after using ECG flash cards to evaluate the efficacy of flash cards in enhancing ECG learning outcomes. A descriptive qualitative study was conducted on the satisfaction with the flash cards.Results:Before the intervention, there was no significant difference in the score of students from different majors. For students who had studied ECG within 1 month and 6 months, the difference in correct recognition rate between them was relatively small, which were 57.50% and 54.51%, respectively. For students who had not studied ECG, the correct recognition rate after training was only 18.06%. After the intervention, 42 valid questionnaires were collected. The overall correct rate of ECG recognition increased by 17.86%. The correct recognition rate of ventricular fibrillation increased significantly from 30.91% to 64.29%; the correct recognition rate of supraventricular tachycardia was improved only by 5.50%. The correct ECG recognition rate was significantly higher after the intervention than before the intervention ( P<0.01). The results of qualitative interviews indicated that the ECG game cards were interesting, practical, and generalizable. However, there was room for improvement in the distinctiveness of key graphics, the richness of information on cards, and the diversity of rule design. Conclusions:ECG recognition is hard to master for beginners. The use of ECG flash cards simplifies the process of ECG recognition and stimulates students' initiative in learning, thus improving the overall correct ECG recognition rate.

Objective:To search, evaluate, and summarize the best evidence for postpartum contraceptive health guidance, providing evidence-based support for clinical healthcare providers in implementing standardized contraceptive counseling and management.Methods:A systematic search was conducted across guideline repositories, professional association websites, and databases for literature related to postpartum contraception guidance, including guidelines, best practices, expert consensus, and systematic reviews, with a search timeframe from database inception to December 2023. Four researchers independently evaluated the quality of the included studies, extracted relevant data, and synthesized evidence from eligible literature.Results:According to the inclusion and exclusion criteria, 18 documents were included, comprising 5 guidelines, 2 clinical decision-making documents, 1 best practice document, 4 expert consensus statements, and 6 meta-analyses or systematic reviews. Totally 46 pieces of best evidence were summarized from 9 aspects, including health educators, health education recipients, assessment, planning, mode and content of health education, available contraceptive methods, evaluation index of health education, and considerations.Conclusion:This study systematically synthesizes the best available evidence on postpartum contraceptive health guidance. It emphasizes strengthening the competencies of clinical practitioners, supported by structured assessments and standardized guidance, to improve the feasibility and accessibility of contraceptive services. It further highlights the importance of ensuring the long-term sustainability of contraceptive plans and integrating digital tools to enhance the precision and coverage of guidance, ultimately reducing unintended and short-interval pregnancies and safeguarding women's reproductive health.

Objective To investigate the effect and safety of esketamine combined with general anesthesia and ultrasound-guided cervical plexus block in axillary endoscopic thyroidectomy.Methods The subjects of this study,112 female patients who underwent axillary endoscopic thyroidectomy in our hospital from January 2022 to October 2024,were randomly divided into an observation group and a control group,each with 56 cases.All patients were administered with ultrasound-guided cervical plexus block followed by general anesthesia.The observation group was injected with 0.1 mg/kg of esketamine prior to anesthesia induction and continuously pumped with esketamine at a rate of 0.1 mg/(kg·h)during the operation until sutures were completed,while the control group was administered with an equal volume of normal saline following the same procedure.The vital sign indicators[mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO2)]immediately after establishing electrocardiogram monitoring(T0),immediately before tracheal intubation(T1),immediately after tracheal intubation(T2),immediately after skin incision(T3)and immediately after the operation(T4)were compared between the two groups.Surgical related indicators such as propofol dosage,remifentanil dosage,and extubation time were also compared between them.Pain visual analogue scale(VAS)scores were performed on patients from the two groups at 1,6,12,and 24 h postoperatively.The 40-item quality of recovery score(QoR-40)was used before the surgeries and 1 d after surgeries to assess the patients.Adverse reactions were also compared.Results The difference was significant in terms of MAP,HR time effect in the two groups(F=24.63,F=20.11,P<0.05)and inter-group MAP,HR values(F=13.54,F=11.49,P<0.05).There were statistically significant differences in the interaction effects of MAP and HR between the two groups(F=4.10,F=3.46,P<0.05).The difference was not statistically significant in time,inter group,and interaction effects of SpO2(P>0.05).The dosage of propofol,remifentanil,and postoperative 1 d drainage in the observation group were less than those in the control group,the differences were statistically significant(P<0.05).The differences were not statistically signiciant in extubation time and awakening time between the two groups(P>0.05).The VAS scores at 1,6,12,and 24 h after operation in the observation groups were lower than those in the control group,the differences were statistically significant(P<0.05).Physical comfort,pain dimension ratings,and total score of the QoR-40 scale:1)those 1 d after operation were lower than those before operation in both groups(P<0.05);2)1 d after operation:those in the control group were lower than those in the observation group(P<0.05).The control group witnessed a remarkable decrease in QoR-40 emotional state rating 1 d after operation than it did before operation(P<0.05),while no significant change was seen by the observation group in this regard(P>0.05).The incidence of coughing after extubation in the observation group was lower than that in the control group(14.29%and 37.50%),the difference was statistically significant(P<0.05).The differences were not statistically signiciant in the incidence of other adverse reactions such as nausea,vomiting,dizziness,headache,respiratory depression,awakening restlessness and awakening delirium between the two groups(P>0.05).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(25.00%and 66.07%,P<0.05).Conclusion The application of esketamine combined with general anesthesia and ultrasound-guided cervical plexus block in axillary endoscopic thyroidectomy can significantly stabilize hemodynamics in patients,reduce postoperative pain,and promote postoperative recovery.It is worthy clinical application.