Objective:To investigate the correlation between vasoactive-inotropic score and 30-day mortality after surgery in acute Stanford type A aortic dissection(ATAAD) patients.Methods:The clinical data of 242 patients with ATAAD who underwent surgical treatment was retrospectively analyzed between November 2015 and May 2024. There were 172 males and 70 females. The average age was(53.1±11.9) years, ranging from 28 to 85 years. Patients were divided into death group(18 cases) and survival group(224 cases) according to the 30-day outcomes after surgery. The VIS at different time points and perioperative indexes of two groups of patients were analyzed, and multivariate logistic regression was used to analyze the risk factors of 30-day mortality after surgery in ATAAD patients. The receiver operating characteristic curve( ROC) was drawn to evaluate the predictive value of vasoactive-inotropic score. Results:Among 242 ATAAD patients, 18 patients died within 30 days after surgery, with a mortality rate of 7.4%. The age, incidence of pericardial tamponade/cardiogenic shock, incidence of malperfusion syndrome, cardiopulmonary bypass time, red blood cell transfusion intraoperative and in 24 hours postoperatively, ventilator assisted time, and incidence of major postoperative complications of patients in the death group were significantly higher than those in the survival group( P<0.05). The VIS of the death group was significantly higher than that of the survival group at all time points( P<0.05). The area under the receiver operating characteristic curve( AUC) of VIS for predicting death at each time point was greater than 0.500( P<0.05), with the highest AUC(0.906) of the second 24 hours(VISmax48h) in ICU. The optimal cut off value was determined to be 9, with a sensitivity of 0.944 and a specificity of 0.821. Logistic regression analysis showed that the VISmax48h of the second 24 hours in ICU was an independent risk factor for 30-day mortality after surgery in ATAAD patients( OR=1.462, 95% CI: 1.230-1.737, P<0.05). Conclusion:When VISmax48h≥9, patients with ATAAD have an increased risk of mortality after surgery. VISmax48h, cardiopulmonary bypass time, and red blood cell transfusion intraoperative in 24 hours postoperatively are independent risk factors for the 30-day mortality of ATAAD patients.

Objective:To explore the risk factors of enteral nutrition (EN) intolerance in patients with severe acute cerebral infarction (ACI) and analyze its impact on postoperative neurorehabilitation.Methods:A retrospective selection was made of 199 patients with severe ACI admitted to Zhoushan Hospital from January 2022 to May 2024. According to whether the patients developed feeding intolerance, they were divided into the feeding intolerance group (90 cases) and the feeding tolerance group (109 cases). The clinical data of the two groups were compared. Multivariate Logistic regression analysis was used to analyze the independent risk factors of feeding intolerance in patients with severe ACI, and the impact of EN intolerance on the National Institutes of Health Stroke Scale (NIHSS) score was analyzed.Results:The age, bed rest time, EN speed and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) score in the feeding intolerance group were higher than those in the feeding tolerance group: (71.54 ± 11.44) years vs. (67.83 ± 13.82) years, (67.83 ± 13.82) d vs.(17.11 ± 8.41)d ,(61.50 ± 10.34) ml/h vs.(57.48 ± 7.95) ml/h,(22.68 ± 4.73) scores vs.(21.25 ± 5.12) scores; and the proportion of consciousness disorder and gastric tube use were higher than those in the feeding tolerance group: 56.7%(51/90) vs. 36.7%(40/109), 97.8%(88/90) vs. 89.0%(97/109); there were statistical differences ( P<0.05). The results of multivariate Logistic regression analysis indicated that old age, consciousness disorder, faster EN speed, and the use of gastric tubes were independent risk factors for EN intolerance in patients with severe ACI ( P<0.05). At 7 d after the start of EN, the total serum protein and hemoglobin in the feeding intolerance group were lower than those in the feeding tolerance group : (62.09 ± 6.07) g/L vs. (63.70 ± 5.34) g/L, (118.60 ± 17.01) g/L vs. (124.69 ± 18.51) g/L; and the scores of NIHSS was higher than that in the feeding tolerance group: (14.89 ± 7.68) scores vs. (12.40 ± 8.97) scores, there were statistical differences ( P<0.05). Conclusions:Old age, consciousness disorders, fast EN speed and the use of gastric tubes are risk factors for EN intolerance in severe ACI patients.

Objective:To evaluate the efficacy of eradication therapy based on potassium-competitive acid blocker (P-CAB) for Helicobacter pylori( HP) infection in re-eradication therapy (the second-line therapy treatment after initial eradication failure of HP infection) and determine whether it can achieve the ideal eradication rate (90%). Methods:From January 2022 to December 2023, the clinical data of patients who received vonoprazan-based HP re-eradication therapy were collected in Department of Gastroenterology, the First Affiliated Hospital of Soochow University. The patients were divided into 4 groups according to their different HP treatment regimens, including VAMB group (vonoprazan 20 mg, quaque die( qd)+ amoxicillin 1 g, bis in die( bid)+ minocycline 100 mg, bid+ potassium bismuth citrate 220 mg, bid; 156 cases), VA group (vonoprazan 20 mg, bid+ amoxicillin 1 g, ter in die( tid); 44 cases), VMFB group (vonoprazan 20 mg qd+ minocycline 100 mg, bid+ furazolidone 100 mg, bid+ potassium bismuth citrate 220 mg, bid; 42 cases), and VAFB group (vonoprazan 20 mg, qd+ amoxicillin 1 g, bid+ furazolidone 100 mg, bid + potassium bismuth citrate 220 mg, bid; 13 cases). All the 4 groups of patients took the medication for 14 days. The 13C or 14C urea breath test would be conducted 4 weeks after the treatment. The overall eradication rate to evaluate the treatment efficacy. The eradication rate and adverse reaction rate were calculated for each group, and the eradication rates and adverse reaction rates between groups were compared using the chi-square test or Fisher′s exact test. Results:The total eradication rate of HP infection based on P-CAB therapy was 91.8% (234/255), and the total adverse reaction rate was 5.1% (13/255). The eradication rate and adverse reaction rate were 92.9% (145/156) and 3.2% (5/156) in the VAMB group, 84.1% (37/44) and 0 in the VA group 95.2% (40/42) and 11.9% (5/42) in the VMFB group, 12/13 and 3/13 in the VAFB group, respectively. Additionally, there was no statistical difference in the eradication rate among the 4 groups (Fisher′s exact test, P=0.227), but there was a statistical difference in the adverse reaction rates (Fisher′s exact test, P=0.002), and the adverse reaction rate of the VAFB group was higher than that of VAMB and VA groups and the differences were statistically significant (both Fisher′s excact test, P=0.016 and 0.010). Conclusions:The total HP re-eradication rate based on P-CAB therapies can reach 91.8%, achieving the ideal eradication rate of HP infection. The VA therapeutic regimen has the lowest incidence of adverse reactions, representing a novel therapeutic option for HP re-eradication.

Objective:To explore the risk factors of enteral nutrition (EN) intolerance in patients with severe acute cerebral infarction (ACI) and analyze its impact on postoperative neurorehabilitation.Methods:A retrospective selection was made of 199 patients with severe ACI admitted to Zhoushan Hospital from January 2022 to May 2024. According to whether the patients developed feeding intolerance, they were divided into the feeding intolerance group (90 cases) and the feeding tolerance group (109 cases). The clinical data of the two groups were compared. Multivariate Logistic regression analysis was used to analyze the independent risk factors of feeding intolerance in patients with severe ACI, and the impact of EN intolerance on the National Institutes of Health Stroke Scale (NIHSS) score was analyzed.Results:The age, bed rest time, EN speed and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) score in the feeding intolerance group were higher than those in the feeding tolerance group: (71.54 ± 11.44) years vs. (67.83 ± 13.82) years, (67.83 ± 13.82) d vs.(17.11 ± 8.41)d ,(61.50 ± 10.34) ml/h vs.(57.48 ± 7.95) ml/h,(22.68 ± 4.73) scores vs.(21.25 ± 5.12) scores; and the proportion of consciousness disorder and gastric tube use were higher than those in the feeding tolerance group: 56.7%(51/90) vs. 36.7%(40/109), 97.8%(88/90) vs. 89.0%(97/109); there were statistical differences ( P<0.05). The results of multivariate Logistic regression analysis indicated that old age, consciousness disorder, faster EN speed, and the use of gastric tubes were independent risk factors for EN intolerance in patients with severe ACI ( P<0.05). At 7 d after the start of EN, the total serum protein and hemoglobin in the feeding intolerance group were lower than those in the feeding tolerance group : (62.09 ± 6.07) g/L vs. (63.70 ± 5.34) g/L, (118.60 ± 17.01) g/L vs. (124.69 ± 18.51) g/L; and the scores of NIHSS was higher than that in the feeding tolerance group: (14.89 ± 7.68) scores vs. (12.40 ± 8.97) scores, there were statistical differences ( P<0.05). Conclusions:Old age, consciousness disorders, fast EN speed and the use of gastric tubes are risk factors for EN intolerance in severe ACI patients.

Objective:To investigate the correlation between vasoactive-inotropic score and 30-day mortality after surgery in acute Stanford type A aortic dissection(ATAAD) patients.Methods:The clinical data of 242 patients with ATAAD who underwent surgical treatment was retrospectively analyzed between November 2015 and May 2024. There were 172 males and 70 females. The average age was(53.1±11.9) years, ranging from 28 to 85 years. Patients were divided into death group(18 cases) and survival group(224 cases) according to the 30-day outcomes after surgery. The VIS at different time points and perioperative indexes of two groups of patients were analyzed, and multivariate logistic regression was used to analyze the risk factors of 30-day mortality after surgery in ATAAD patients. The receiver operating characteristic curve( ROC) was drawn to evaluate the predictive value of vasoactive-inotropic score. Results:Among 242 ATAAD patients, 18 patients died within 30 days after surgery, with a mortality rate of 7.4%. The age, incidence of pericardial tamponade/cardiogenic shock, incidence of malperfusion syndrome, cardiopulmonary bypass time, red blood cell transfusion intraoperative and in 24 hours postoperatively, ventilator assisted time, and incidence of major postoperative complications of patients in the death group were significantly higher than those in the survival group( P<0.05). The VIS of the death group was significantly higher than that of the survival group at all time points( P<0.05). The area under the receiver operating characteristic curve( AUC) of VIS for predicting death at each time point was greater than 0.500( P<0.05), with the highest AUC(0.906) of the second 24 hours(VISmax48h) in ICU. The optimal cut off value was determined to be 9, with a sensitivity of 0.944 and a specificity of 0.821. Logistic regression analysis showed that the VISmax48h of the second 24 hours in ICU was an independent risk factor for 30-day mortality after surgery in ATAAD patients( OR=1.462, 95% CI: 1.230-1.737, P<0.05). Conclusion:When VISmax48h≥9, patients with ATAAD have an increased risk of mortality after surgery. VISmax48h, cardiopulmonary bypass time, and red blood cell transfusion intraoperative in 24 hours postoperatively are independent risk factors for the 30-day mortality of ATAAD patients.

Objective:To evaluate the efficacy of eradication therapy based on potassium-competitive acid blocker (P-CAB) for Helicobacter pylori( HP) infection in re-eradication therapy (the second-line therapy treatment after initial eradication failure of HP infection) and determine whether it can achieve the ideal eradication rate (90%). Methods:From January 2022 to December 2023, the clinical data of patients who received vonoprazan-based HP re-eradication therapy were collected in Department of Gastroenterology, the First Affiliated Hospital of Soochow University. The patients were divided into 4 groups according to their different HP treatment regimens, including VAMB group (vonoprazan 20 mg, quaque die( qd)+ amoxicillin 1 g, bis in die( bid)+ minocycline 100 mg, bid+ potassium bismuth citrate 220 mg, bid; 156 cases), VA group (vonoprazan 20 mg, bid+ amoxicillin 1 g, ter in die( tid); 44 cases), VMFB group (vonoprazan 20 mg qd+ minocycline 100 mg, bid+ furazolidone 100 mg, bid+ potassium bismuth citrate 220 mg, bid; 42 cases), and VAFB group (vonoprazan 20 mg, qd+ amoxicillin 1 g, bid+ furazolidone 100 mg, bid + potassium bismuth citrate 220 mg, bid; 13 cases). All the 4 groups of patients took the medication for 14 days. The 13C or 14C urea breath test would be conducted 4 weeks after the treatment. The overall eradication rate to evaluate the treatment efficacy. The eradication rate and adverse reaction rate were calculated for each group, and the eradication rates and adverse reaction rates between groups were compared using the chi-square test or Fisher′s exact test. Results:The total eradication rate of HP infection based on P-CAB therapy was 91.8% (234/255), and the total adverse reaction rate was 5.1% (13/255). The eradication rate and adverse reaction rate were 92.9% (145/156) and 3.2% (5/156) in the VAMB group, 84.1% (37/44) and 0 in the VA group 95.2% (40/42) and 11.9% (5/42) in the VMFB group, 12/13 and 3/13 in the VAFB group, respectively. Additionally, there was no statistical difference in the eradication rate among the 4 groups (Fisher′s exact test, P=0.227), but there was a statistical difference in the adverse reaction rates (Fisher′s exact test, P=0.002), and the adverse reaction rate of the VAFB group was higher than that of VAMB and VA groups and the differences were statistically significant (both Fisher′s excact test, P=0.016 and 0.010). Conclusions:The total HP re-eradication rate based on P-CAB therapies can reach 91.8%, achieving the ideal eradication rate of HP infection. The VA therapeutic regimen has the lowest incidence of adverse reactions, representing a novel therapeutic option for HP re-eradication.

Objective : Mendelian randomization analysis was used to explore the causal relationship of T．gondii in- fection and the cyst distribution and inflammation in brain tissue by immunohistochemistry． Methods : Genome- wide association analysis data of T．gondii infection and encephalitis were obtained ，single nucleotide polymor- phisms (SNPs) were selected，Mendelian randomization analysis was conducted by inverse variance weighting，and the causal relationship between T．gondii infection and encephalitis was evaluated by OR value and 95% CI．Quality control was carried out by using heterogeneity test，horizontal multi-efficiency test and leave-one-out sensitivity test. Immunohistochemical staining was performed using brain sections of mice infected with tissue cysts of Wh6 strain for image analysis using Image J software. Results : A total of 29 SNPs were associated with toxoplasmic encephalitis. The results of IVW method suggested that T．gondii infection made encephalitis risk 0. 98 times higher ( OR = 0. 98， 95% CI = 0. 76 to 1. 27) ，indicating no causal relationship between the two．The quality control results suggested that the selected SNPs were stable and reliable．Toxoplasma cysts were distributed in various parts of the brain tis- sue． Conclusion T．gondii infection and encephalitis are related，but there is no sufficient evidence to prove the causal relationship between the two.

Objective To investigate the protective effect of Gubi Tongxiao granules on steroid-induced necrosis of femoral head(SANFH).Methods Femoral head and bone marrow tissues of patients with SANFH and femoral neck fracture(FNF)undergoing hip replacement were collected and studied.The expression levels of phosphatidylinositol 3-kinase(PI3K),protein kinase B(AKT),FoxOl and cholesterol regulatory binding protein(SREBP)were detected in bone tissue.Human bone marrow mesenchymal stem cells(hBMSCs)were isolated and cultured.The effect of the drug-containing serum of Gubitongxiao granule on the proliferation of hBMSCs was detected by CCK-8 method.Oil red O and alizarin red staining were used to observe the adipogenic and osteogenic differentiation of cells.The expression of peroxisome proliferator-activated receptor γ(PPARy),CCATT enhancer binding protein α(C/EBPα),Runt-associated transcription factor 2(Runx2),alkaline phosphatase(ALP)mRNA and pathway protein were analyzed by RT-qPCR and Western blot.Results Western blot results showed that the expression of PI3K,AKT and SREBP protein in femoral head tissue of SANFH patients was significantly increased compared with that of normal group,while FoxOl expression was significantly decreased(P＜0.05);Different volume fractions of Gubi Tongxiao granules could promote the proliferation of hBMSCs,especially in 5％group after 48h.Compared with the model group,5％drug-containing serum could significantly reduce the lipid droplet coloring in the cytoplasm and increase the orange-red mineralized nodules in the calcium salt deposit,down-regulate the mRNA expression levels of PPARγ and C/EBPα,and up-regulate the mRNA expression levels of Runx2 and ALP(P＜0.05).In addition,after the intervention of drug-containing serum,the expression of FoxO1 protein in cells was significantly increased,and the expression of AKT,p-FoxO1 and SREBP protein was decreased(P＜0.05).Conclusion After the intervention of Gubi Tongxiao granules,the lipid differentiation of hBMSCs decreased and the osteogenic differentiation increased,which can effectively improve the lipid deposition in glucocorticoid environment,and the mechanism may be related to the regulation of PI3K/AKT/FoxO1 signaling pathway.

Objective To investigate the protective effect of Gubi Tongxiao granules on steroid-induced necrosis of femoral head(SANFH).Methods Femoral head and bone marrow tissues of patients with SANFH and femoral neck fracture(FNF)undergoing hip replacement were collected and studied.The expression levels of phosphatidylinositol 3-kinase(PI3K),protein kinase B(AKT),FoxOl and cholesterol regulatory binding protein(SREBP)were detected in bone tissue.Human bone marrow mesenchymal stem cells(hBMSCs)were isolated and cultured.The effect of the drug-containing serum of Gubitongxiao granule on the proliferation of hBMSCs was detected by CCK-8 method.Oil red O and alizarin red staining were used to observe the adipogenic and osteogenic differentiation of cells.The expression of peroxisome proliferator-activated receptor γ(PPARy),CCATT enhancer binding protein α(C/EBPα),Runt-associated transcription factor 2(Runx2),alkaline phosphatase(ALP)mRNA and pathway protein were analyzed by RT-qPCR and Western blot.Results Western blot results showed that the expression of PI3K,AKT and SREBP protein in femoral head tissue of SANFH patients was significantly increased compared with that of normal group,while FoxOl expression was significantly decreased(P＜0.05);Different volume fractions of Gubi Tongxiao granules could promote the proliferation of hBMSCs,especially in 5％group after 48h.Compared with the model group,5％drug-containing serum could significantly reduce the lipid droplet coloring in the cytoplasm and increase the orange-red mineralized nodules in the calcium salt deposit,down-regulate the mRNA expression levels of PPARγ and C/EBPα,and up-regulate the mRNA expression levels of Runx2 and ALP(P＜0.05).In addition,after the intervention of drug-containing serum,the expression of FoxO1 protein in cells was significantly increased,and the expression of AKT,p-FoxO1 and SREBP protein was decreased(P＜0.05).Conclusion After the intervention of Gubi Tongxiao granules,the lipid differentiation of hBMSCs decreased and the osteogenic differentiation increased,which can effectively improve the lipid deposition in glucocorticoid environment,and the mechanism may be related to the regulation of PI3K/AKT/FoxO1 signaling pathway.

Objective:To investigate the medication rules of Xin'an medicine for the treatment of melancholia and further analyze the medication ideas of Xin'an physicians in the treatment of melancholia.Methods:The documents of Xin'an physicians treating melancholia in the fifth edition of the Chinese Medical Code and the online database of ancient Chinese medicine were retrieved. Excel was used to extract the prescription information to establish the database. R language was used to analyze the data regarding the medication frequency, nature and taste, association rules, and clustering of the traditional Chinese medicine used in the prescription. Results:A total of 127 effective prescriptions were sorted out, and 177 kinds of Chinese medicines were used with a total medication frequency of 1 031 times. The top three Chinese medicines with the highest frequency of use were Poria cocos (57 times), Licorice (46 times), and Paeonia Lactiflora (40 times). The main nature of herbs was plain and warm nature. The warm herbs were the most frequently used (298 times). The first five flavors of the herbs which were the most used were pungent taste (475 times, 28.70%), bitter taste (459 times, 27.73%), and sweet taste (453 times, 27.37%). The commonly used herbs with confidence coefficient > 0.800 were Licorice + Angelica sinensis, Licorice + Angelica sinensis and Paeonia Lactiflora, Licorice + Bupleurum, Licorice + Atractylodes macrocephala, Cyperus root + Ligusticum Chuanxiong, Angelica sinensis + Atractylodes macrocephala and Licorice, Paeonia Lactiflora + Angelica sinensis and Poria cocos, Licorice + Angelica sinensis and Poria cocos, Licorice + Atractylodes macrocephala and Angelica sinensis, Licorice + Bupleurum and Paeonia Lactiflora, Licorice + Atractylodes macrocephala and Ginseng, Licorice + Ginseng and Angelica sinensis, Cyperus root + Medicated leaven, Ginseng + Astragalus mongholicus, Licorice + Astragalus mongholicus.Conclusion:Xin'an medicine for the treatment of melancholia mainly uses pungent, bitter, sweet, and warm herbs. It can adjust the chill and fever, Yin and Yang of the human body, diminishes the urgency, and regulates the flow of Qi.