OBJECTIVE To predict and verify the mechanism of Jiawei qifang weitong granule in ameliorating precancerous lesions of gastric cancer （PLGC）. METHODS Transcriptomic data of PLGC-related were obtained from the GEO database to screen differentially expressed genes and conduct functional enrichment analysis. Targets related to gastric mucosal injury repair were screened via the GeneCards database. The active ingredient targets of Jiawei qifang weitong granule were predicted using the TCMSP and other databases. The intersection of differentially expressed genes， gastric mucosal repair targets and active ingredient targets was extracted. A protein-protein interaction network was constructed based on the STRING database， and the top 6 hub target genes with the highest connectivity were screened. A PLGC rat model was established by combining 1-methyl-3-nitro-1-nitrosoguanidine with alternating fasting and full feeding. Model rats were divided into model group， weifuchun group （positive control， 0.40 g/kg）， low-， medium- and high-dose Jiawei qifang weitong granule groups （9.73， 19.44， 38.90 g/kg）， with 10 rats in each group. Another 10 unmodeled rats were set as control group. Rats in each group were intragastrically administered corresponding liquid medicine or normal saline once a day for 30 consecutive days. After the last administration， pathological morphological changes of rat gastric tissues were observed， and the mRNA expression levels of hub target genes as well as partial protein expression levels in gastric tissues were detected. RESULTS Transcriptomics and network pharmacology analyses revealed that the top 6 hub target genes ranked by connectivity included MMP9 （matrix metalloproteinase 9）， BCL2（B-cell lymphoma 2）， IL10（interleukin 10），ICAM1（intercellular adhesion molecule 1）， PTGS2 （prostaglandin-endoperoxide synthase 2）， and HIF1A （hypoxia-inducible factor 1α subunit）. Animal experiments showed that compared with the model group， gastric mucosal pathological injury was significantly alleviated in medium- and high-dose Jiawei qifang weitong granule groups and weifuchun group. The pathological injury score of gastric mucosa， the mRNA expression levels of MMP9， PTGS2， ICAM1， BCL2 and HIF1A， as well as the protein expression levels of PTGS2 and BCL2 in gastric tissues were significantly decreased （P＜0.05）， while the mRNA expression level of IL10 was significantly increased （P＜0.05）. CONCLUSIONS Jiawei qifang weitong granule may ameliorate PLGC by targeted down-regulating the mRNA expression of MMP9， PTGS2， ICAM1， BCL2 and HIF1A， up-regulating IL10 mRNA expression， and regulating the imbalance between gastric mucosal inflammatory response and injury repair.

Objective:To analyze the influence of Internet + health coach technology (E-Coach) management mode on anticoagulant management and negative mood in patients with atrial fibrillation, and to provide intervention measures for improving anticoagulant management and alleviating negative mood in patients with atrial fibrillation.Methods:Using single-center randomized control study, 78 patients with atrial fibrillation from June 2022 to June 2023 in the Second Hospital, Jiaxing City by convenience sampling method was divided into intervention group (E-Coach management mode based on routine management) and control group (routine management) by random digits table method, 39 cases in each group. The intervention time was 6 months. The anticoagulant knowledge mastery situation, medication compliance, anxiety and depression scores were evaluated before and after the intervention in the two groups. The number of international normalized ratio (INR) full monitoring, days required for INR to reach the first standard (2.0-3.0), the rate of effective anticoagulation, the number of monitoring after INR≤3, bleeding and thrombosis were compared between the two groups.Results:One case was lost to follow-up in the intervention group, and three cases were lost to follow-up in the control group. The final trial intervention group consisted of 38 cases, while the control group consisted of 36 cases. There were 10 males and 26 females in the control group, aged (57.78 ± 10.50) years old, and 12 males and 26 females in the intervention group, aged (60.16 ± 9.86) years old. There were no significant differences in the anticoagulation knowledge mastery situation, medication compliance, anxiety and depression scores (all P>0.05). After the intervention, the scores of anticoagulation knowledge mastery and medication compliance were (13.68 ± 2.11), (7.39 ± 0.42) points in the intervention group, and (9.08 ± 1.93), (5.91 ± 0.85) points in the control group. There were significant differences between the two groups ( t=-9.77, -9.58, both P<0.01). The depression and anxiety scores were (48.74 ± 7.68), (50.61 ± 6.15) points in the intervention group, and (62.97 ± 9.66), (56.42 ± 7.13) points in the control group. There were significant difference between the two groups ( t=7.04, 3.76, both P<0.01). The number of INR full monitoring, days required for INR to reach the first standard, the rate of effective anticoagulation, and the number of monitoring after INR≤ 3 were (10.42 ± 2.04) times, (6.66 ± 1.70) times, 58.1%(25/38), 2.6%(1/38) in the intervention group, and (7.94 ± 1.76) times, (12.72 ± 2.45) times, 33.3%(12/36), 25.0%(9/36) in the control group. There were significant difference between the two groups ( t= -5.59, 12.45, χ2=4.84, 6.12, all P<0.05). Conclusions:E-Coach management mode effectively improves the anticoagulant management ability of patients with atrial fibrillation and reduces their negative emotions.

A 36-year-old male developed unconsciousness and no response to voice stimuli after taking approximately 2 050 mg felodipine (the specific time was unknown). Two hours later, he was sent to the department of emergency by his family and admitted to the hospital. His vital signs showed body temperature 35.1 ℃, pulse 148 times/min, respiration 32 times/min, and blood pressure 65/34 mmHg. Acute drug poisoning, acute toxic cardiomyopathy, acute toxic shock, acute type Ⅱ respiratory failure, acute toxic encephalopathy, and acute renal failure were diagnosed based on the patient′s clinical manifestations combined with laboratory tests results, cardiac ultrasound, chest and abdominal CT scans. Endotracheal intubation connected to a ventilator for invasive assisted ventilation, pressure boosting, and fluid resuscitation were given. At the same time, repeated gastric lavage and enema were performed to remove toxins. Blood perfusion was intermittently and repeatedly administered, and continuous renal replacement therapy was used. The blood concentration of felodipine was 1 298 μg/L at 2 hours after admission, and cardiac arrest occurred at 4 hours. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) treatment was administered immediately. After 48 hours of ECMO operation, sedatives were discontinued and the patient′s consciousness was improved after 4 hours. On the 5th day of ECMO treatment, his heart rate was 72 beats per minute, and blood pressure was 127/65 mmHg. The blood concentration of felodipine decreased to 2 μg/L. The patient′s vital signs were significantly improved and ECMO supportive treatment was withdrawn. After 26 days of hospitalization, the patient recovered and was discharged.

Objective:To investigate the efficacy and safety of dupilumab in the treatment of elderly patients (≥ 60 years old) with atopic dermatitis (AD), with particular attention paid to rare adverse reactions.Methods:A single-center retrospective analysis was conducted on data collected from 281 elderly AD patients who received the standard regimen of dupilumab at the Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to May 2024. Clinical characteristics such as gender, disease duration, skin lesion manifestations, and itch severity were analyzed. Changes in skin lesions and itch severity, as well as related adverse events were recorded during the follow-up period of 0 - 16 weeks. The efficacy and safety of dupilumab in the treatment of elderly AD patients were evaluated.Results:Among the 281 elderly AD patients, 214 were males (76.16%) and 67 were females (23.84%), with the age being 71.13 ± 7.91 years and the age at onset being 59.92 ± 15.72 years. The disease duration ( M[ IQR]) was 5.00 (13.00) years. After standard-regimen dupilumab treatment, the improvement rates of clinical outcome indicators SCORing Atopic Dermatitis (SCORAD) and pruritus numerical rating scale (NRS) scores gradually increased. At week 16, the improvement rates of SCORAD and NRS scores ( M[ IQR]) reached the maxima of 72.37% (23.89%) and 75.00% (29.72%), respectively. The overall incidence of adverse events was relatively low, with only 16 patients (6.05%) reporting adverse events. Common adverse reactions such as conjunctivitis (2 cases, 0.71%) and facial erythema (1 case, 0.36%) were mild and well-tolerated. Phenotype switching occurred in 10 cases (3.56%) . Conclusion:Dupilumab was an effective and safe treatment for elderly AD, but phenotype switching may occur.

Objective To systematically retrieve,assess and synthesise regarding the respiratory training for patients with spinal cord injury and to provide a reference for clinical practice.Methods According to the 6S Evidence Pyramid Model,following databases were searched for literature in relation to the respiratory training for patients with spinal cord injury:UpToDate,BMJ Best Practice,Joanna Briggs Institute Database of Systematic Reviews and Implementations,National Institute for Health and Clinical Excellence(NICE),National Guideline Clearinghouse(NGC),Registered Nurses'Association of Ontario(RNAO),Medlive,American Spinal Injury Association(ASIA),Physiotherapy Evidence Database(PEDro),The Cochrane Library,PubMed,Web of Science,CNKI,Wanfang Data,SinoMed and the websites of the Journals published by Chinese Medical Association.The types of literature included clinical decisions,practice guidelines,expert consensus,evidence summaries,systematic reviews/Meta-analyses,and original researches.The search period was from the inception of databases to 30th December,2023.Two researchers independently evaluated the quality of the literature and summarised the evidences.Results Fifteen studies were ultimately included,comprising 3 clinical decisions,3 guidelines,6 systematic reviews and 3 randomised controlled trials.A total of 21 best pieces of evidence were summarised,covering 5 aspects:pre-training assessment,training content,training equipment,training intensity and frequency,and effectiveness evaluation.Conclusion The best evidence of respiratory training for patients with spinal cord injury summarised in this study can provide the evidence-based support for healthcare professionals to formulate standardised respiratory training strategies.

With the adjustment of China's fertility policies, the proportion of advanced maternal age pregnancies has increased, making early identification of critical conditions in this population essential for successful treatment. This article systematically reviews the development of obstetric early warning management systems and advances in machine learning-based artificial intelligence for risk assessment in high-risk pregnant women. As artificial intelligence technology continues to evolve, future developments will include intelligent electronic medical record systems for high-risk pregnant women, generate clinical decision support solutions for early warning management, and establish coordinated critical care systems for severely ill pregnant women.

Objective:To investigate the efficacy and safety of dupilumab in the treatment of elderly patients (≥ 60 years old) with atopic dermatitis (AD), with particular attention paid to rare adverse reactions.Methods:A single-center retrospective analysis was conducted on data collected from 281 elderly AD patients who received the standard regimen of dupilumab at the Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to May 2024. Clinical characteristics such as gender, disease duration, skin lesion manifestations, and itch severity were analyzed. Changes in skin lesions and itch severity, as well as related adverse events were recorded during the follow-up period of 0 - 16 weeks. The efficacy and safety of dupilumab in the treatment of elderly AD patients were evaluated.Results:Among the 281 elderly AD patients, 214 were males (76.16%) and 67 were females (23.84%), with the age being 71.13 ± 7.91 years and the age at onset being 59.92 ± 15.72 years. The disease duration ( M[ IQR]) was 5.00 (13.00) years. After standard-regimen dupilumab treatment, the improvement rates of clinical outcome indicators SCORing Atopic Dermatitis (SCORAD) and pruritus numerical rating scale (NRS) scores gradually increased. At week 16, the improvement rates of SCORAD and NRS scores ( M[ IQR]) reached the maxima of 72.37% (23.89%) and 75.00% (29.72%), respectively. The overall incidence of adverse events was relatively low, with only 16 patients (6.05%) reporting adverse events. Common adverse reactions such as conjunctivitis (2 cases, 0.71%) and facial erythema (1 case, 0.36%) were mild and well-tolerated. Phenotype switching occurred in 10 cases (3.56%) . Conclusion:Dupilumab was an effective and safe treatment for elderly AD, but phenotype switching may occur.

A 36-year-old male developed unconsciousness and no response to voice stimuli after taking approximately 2 050 mg felodipine (the specific time was unknown). Two hours later, he was sent to the department of emergency by his family and admitted to the hospital. His vital signs showed body temperature 35.1 ℃, pulse 148 times/min, respiration 32 times/min, and blood pressure 65/34 mmHg. Acute drug poisoning, acute toxic cardiomyopathy, acute toxic shock, acute type Ⅱ respiratory failure, acute toxic encephalopathy, and acute renal failure were diagnosed based on the patient′s clinical manifestations combined with laboratory tests results, cardiac ultrasound, chest and abdominal CT scans. Endotracheal intubation connected to a ventilator for invasive assisted ventilation, pressure boosting, and fluid resuscitation were given. At the same time, repeated gastric lavage and enema were performed to remove toxins. Blood perfusion was intermittently and repeatedly administered, and continuous renal replacement therapy was used. The blood concentration of felodipine was 1 298 μg/L at 2 hours after admission, and cardiac arrest occurred at 4 hours. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) treatment was administered immediately. After 48 hours of ECMO operation, sedatives were discontinued and the patient′s consciousness was improved after 4 hours. On the 5th day of ECMO treatment, his heart rate was 72 beats per minute, and blood pressure was 127/65 mmHg. The blood concentration of felodipine decreased to 2 μg/L. The patient′s vital signs were significantly improved and ECMO supportive treatment was withdrawn. After 26 days of hospitalization, the patient recovered and was discharged.

Objective:To analyze the influence of Internet + health coach technology (E-Coach) management mode on anticoagulant management and negative mood in patients with atrial fibrillation, and to provide intervention measures for improving anticoagulant management and alleviating negative mood in patients with atrial fibrillation.Methods:Using single-center randomized control study, 78 patients with atrial fibrillation from June 2022 to June 2023 in the Second Hospital, Jiaxing City by convenience sampling method was divided into intervention group (E-Coach management mode based on routine management) and control group (routine management) by random digits table method, 39 cases in each group. The intervention time was 6 months. The anticoagulant knowledge mastery situation, medication compliance, anxiety and depression scores were evaluated before and after the intervention in the two groups. The number of international normalized ratio (INR) full monitoring, days required for INR to reach the first standard (2.0-3.0), the rate of effective anticoagulation, the number of monitoring after INR≤3, bleeding and thrombosis were compared between the two groups.Results:One case was lost to follow-up in the intervention group, and three cases were lost to follow-up in the control group. The final trial intervention group consisted of 38 cases, while the control group consisted of 36 cases. There were 10 males and 26 females in the control group, aged (57.78 ± 10.50) years old, and 12 males and 26 females in the intervention group, aged (60.16 ± 9.86) years old. There were no significant differences in the anticoagulation knowledge mastery situation, medication compliance, anxiety and depression scores (all P>0.05). After the intervention, the scores of anticoagulation knowledge mastery and medication compliance were (13.68 ± 2.11), (7.39 ± 0.42) points in the intervention group, and (9.08 ± 1.93), (5.91 ± 0.85) points in the control group. There were significant differences between the two groups ( t=-9.77, -9.58, both P<0.01). The depression and anxiety scores were (48.74 ± 7.68), (50.61 ± 6.15) points in the intervention group, and (62.97 ± 9.66), (56.42 ± 7.13) points in the control group. There were significant difference between the two groups ( t=7.04, 3.76, both P<0.01). The number of INR full monitoring, days required for INR to reach the first standard, the rate of effective anticoagulation, and the number of monitoring after INR≤ 3 were (10.42 ± 2.04) times, (6.66 ± 1.70) times, 58.1%(25/38), 2.6%(1/38) in the intervention group, and (7.94 ± 1.76) times, (12.72 ± 2.45) times, 33.3%(12/36), 25.0%(9/36) in the control group. There were significant difference between the two groups ( t= -5.59, 12.45, χ2=4.84, 6.12, all P<0.05). Conclusions:E-Coach management mode effectively improves the anticoagulant management ability of patients with atrial fibrillation and reduces their negative emotions.

Objective To systematically retrieve,assess and synthesise regarding the respiratory training for patients with spinal cord injury and to provide a reference for clinical practice.Methods According to the 6S Evidence Pyramid Model,following databases were searched for literature in relation to the respiratory training for patients with spinal cord injury:UpToDate,BMJ Best Practice,Joanna Briggs Institute Database of Systematic Reviews and Implementations,National Institute for Health and Clinical Excellence(NICE),National Guideline Clearinghouse(NGC),Registered Nurses'Association of Ontario(RNAO),Medlive,American Spinal Injury Association(ASIA),Physiotherapy Evidence Database(PEDro),The Cochrane Library,PubMed,Web of Science,CNKI,Wanfang Data,SinoMed and the websites of the Journals published by Chinese Medical Association.The types of literature included clinical decisions,practice guidelines,expert consensus,evidence summaries,systematic reviews/Meta-analyses,and original researches.The search period was from the inception of databases to 30th December,2023.Two researchers independently evaluated the quality of the literature and summarised the evidences.Results Fifteen studies were ultimately included,comprising 3 clinical decisions,3 guidelines,6 systematic reviews and 3 randomised controlled trials.A total of 21 best pieces of evidence were summarised,covering 5 aspects:pre-training assessment,training content,training equipment,training intensity and frequency,and effectiveness evaluation.Conclusion The best evidence of respiratory training for patients with spinal cord injury summarised in this study can provide the evidence-based support for healthcare professionals to formulate standardised respiratory training strategies.