ObjectiveTo evaluate the effects and safety of the optimized new Shengmai Powder （优化新生脉散方） on exercise tolerance in patients with chronic heart failure （CHF） of qi deficiency， blood stasis， and fluid retention syndrome. MethodsA randomized， double-blind， placebo-controlled trial was conducted. A total of 78 CHF patients with qi deficiency， blood stasis， and fluid retention syndrome were recruited and randomly assigned to a treatment group （39 cases） and a control group （39 cases）. On the basis of conventional western medical therapy， patients in the treatment group additionally received the optimized new Shengmai Powder granules， while the control group was given an oral placebo of optimized new Shengmai Powder granules. Patients in both groups took 30.6 g each time， twice a day， mixed with water for administration， with a total treatment course of 4 weeks. The primary outcomes were 6-minute walk distance （6MWD） and peak oxygen uptake （Peak VO₂） measured by cardiopulmonary exercise testing. Secondary outcomes included New York Heart Association （NYHA） functional classification， B-type natriuretic peptide （BNP） levels， cardiac function indexes including left ventricular ejection fraction （LVEF）， left ventri-cular end-systolic diameter （LVESD） and left ventricular end-diastolic diameter （LVEDD）， Minnesota Living with Heart Failure Questionnaire （MLHFQ） scores， and scores of four diagnostic information of traditional Chinese medicine （TCM）. All indicators were assessed once before and after treatment respectively. Safety indicators were evaluated， and adverse events during the trial were recorded. ResultsAll patients in both groups were included in the full ana-lysis set （FAS） and safety set （SS）. Compared with baseline， the 6MWD and Peak VO₂ of cardiopulmonary exercise test in the treatment group significantly increased after treatment， while the MLHFQ scores， serum BNP levels and scores of TCM four diagnostic information significantly decreased， and the NYHA cardiac function grade significantly improved （P＜0.01）. After treatment， the 6MWD and Peak VO₂ of cardiopulmonary exercise test， as well as their changes from baseline in the treatment group were higher than those in the control group； the MLHFQ scores， serum BNP levels and scores of TCM four diagnostic information in the treatment group were lower than those in the control group； and the improvement of NYHA cardiac function grade in the treatment group was superior to that in the control group （P＜0.01）. There was no statistically significant differences in all indicators after treatment in the control group （P＞0.05）. The incidence of adverse events was 5.1% （2/39） in the treatment group and 2.6% （1/39） in the control group， with no statistically significant difference between groups （P＞0.05）. ConclusionOn the basis of conventional western medicine treatment， the addition of the optimized new Shengmai Powder can further improve exercise tolerance， cardiac function and quality of life in patients with CHF of qi deficiency， blood stasis and fluid retention syndrome， and show good safety.

Objective To analyze the current status of occupational health literacy (OHL) among front-line workers in the metal products industry and to explore its influencing factors. Methods A total of 5 193 front-line workers from the metal products industry in 14 prefecture-level cities in Guangdong Province were selected as the research subjects by the stratified cluster random sampling method. The Occupational Health Literacy Questionnaire of National Key Populations was used to assess their OHL levels. To analyze the influencing factors of OHL, binary logistic regression analysis was conducted. Results The overall OHL level among the participants was 40.0% (2 079/5 193). The result of binary logistic regression analysis showed that workers with lower educational level, lower average monthly personal income, and smaller enterprise size had lower OHL levels (all P<0.01). In addition, workers in foreign-funded enterprises had higher OHL levels than those in private enterprises (P<0.01). Conclusion There remains considerable room for improvement in OHL among front-line workers in the metal products industry. Priority focus is to improve OHL among workers with lower education and income levels, as well as those employed in private and micro- or small-sized enterprises.

Objective To investigate the effects of Optimized New Shengmai Powder on myocardial fibrosis in rats with heart failure based on the β1-AR/cAMP/PKA/CREB signaling pathway.Methods Totally 50 SD rats were randomly divided into sham-operation group(10 rats)and operation group(40 rats).The left anterior descending coronary artery was ligated to establish a rat model of heart failure.The modeling rats were randomly divided into the model group,the captopril group,and TCM low-and high-dosage groups,with 8 rats in each group.The administration groups received relevant medicine for gavage for 4 weeks.LVEF and LVFS in rats were detected by echocardiography,and measurement of heart and lung mass and calculation of heart and lung organ coefficients were performed,myocardial fibrosis degree was observed by histopathology,serum NT-ProBNP and cAMP,Col Ⅰ,and Col Ⅲcontent in myocardial tissue were detected by ELISA,immunohistochemical was used to detect β1-AR,cAMP positive expression,and Western blot was used to detect the expression of β1-AR/cAMP/PKA/CREB signaling pathway related proteins.Results Compared with the sham-operation group,the LVEF and LVFS of the model group rats were significantly decreased(P<0.01),and the heart and lung organ coefficient significantly increased(P<0.01);the number of myocardial cells decreased,collagen volume fraction increased,and the proportion of type Ⅰ/Ⅲcollagen fibers increased(P<0.01),the contents of serum NT-ProBNP and myocardial tissue Col Ⅰ and Col Ⅲincreased significantly,while the cAMP content in myocardial tissue decreased significantly(P<0.01),the positive expressions of β1-AR and cAMP were significantly decreased(P<0.01),the expressions of β1-AR,AC1,cAMP,p-PKA,and p-CREB proteins were significantly decreased,while protein expressions of p-Smad2,Col Ⅰ,Col Ⅲ,and α-SMA significantly increased(P<0.05,P<0.01).Compared with the model group,the administration groups could increase LVEF and LVFS and decrease heart and lung organ coefficient to different degrees in rats;increase the number of myocardial cells,decrease collagen volume fraction and the proportion of type Ⅰ/Ⅲ collagen fibers,down-regulate serum NT-ProBNP and the content of Col Ⅰ and Col Ⅲ in myocardial tissue,up-regulate the content of cAMP,increase the positive expressions of β1-AR and cAMP in myocardial tissue,up-regulate β1-AR,AC1,cAMP,p-PKA,p-CREB protein expression,and inhibit p-Smad2,Col Ⅰ,Col Ⅲ,and α-SMA protein expression,in which the effects of the TCM high-dosage group and captopril group were more pronounced(P<0.01,P<0.05).Conclusion Optimized New Shengmai Powder can effectively reduce myocardial fibrosis in heart failure rats,improve myocardial hypertrophy and remodeling,and increase left ventricular contractility,and the mechanism may be related to the activation of the β1-AR/cAMP/PKA/CREB signaling pathway.

Objective To explore the effects of multiple groups of acupoint pre-embedding thread on the autonomic nervous system and gastrointestinal function in patients undergoing gynecological laparo-scopic surgery under general anesthesia.Methods Sixty patients,aged 25-64 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected for laparoscopic gynecological surgery under general anesthesia.Patients were divided into two groups using a random number table method:control group(group C)and acupoint thread embedding group(group M),30 patients in each group.Patients in group M received thread embedding at 10 acupoints in 5 groups,including Neiguan,Sanyinjiao,Geshu,Jueyin,and Weishu on the day before surgery.Patients in group C did not undergo thread embedding at acupoints before surgery.The HR,MAP,normalized unit of low frequency(LF),normalized unit of high frequency(HF)and LF/HF were recorded at 5 minutes before anesthesia induction,immediately after tracheal intu-bation,immediately after establishing pneumoperitoneum,10,20,and 30 minutes after pneumoperitoneum,and when tracheal intubation was removed.Motilin and gastrin concentrations in serum were measured on the day before surgery and 24 hours after surgery.The time of first postoperative exhaust and defecation,as well as the occurrence of nausea and vomiting within 48 hours after surgery were recorded.Results Compared with group C,the HR was significantly lower,and the MAP,the LF and LF/HF in group M were significant-ly reduced at 10,20,and 30 minutes after pneumoperitoneum,while HF was significantly increased(P＜0.05).The first postoperative time of exhaust and defecation in group M was significantly shortened(P＜0.05),and the incidence of nausea and vomiting within 24 hours after surgery was significantly reduced(P＜0.05).The concentrations of motilin and gastrin in serum of group M were significantly increased 24 hours after surgery(P＜0.05).Conclusion The combination of acupoints and pre-embedding thread can regu-late the autonomic nervous function of patients undergoing gynecological laparoscopic surgery under general anesthesia,which is beneficial for the recovery of postoperative gastrointestinal function and improves the quality of rehabilitation.

Objective:To investigate the perioperative impact of closure of mesenteric fissure in laparoscopic right hemicolectomy.Methods:The prospective randomized controlled trial was conducted. The clinical data of 320 patients who underwent laparoscopic right hemicolectomy in 11 medical centers, including The First Affiliated Hospital of China Medical University et al, from November 2022 to August 2023 were selected. Based on block randomization, patients were alloca-ted into the mesenteric fissure non-closure group and the mesenteric fissure closure group. Observa-tion indicators: (1) grouping of the enrolled patients; (2) intraoperative conditions; (3) postopera-tive conditions. Measurement data with skewed distribution were represented as M( Q1, Q3) and com-parison between groups was conducted using the Mann-Whitney U test. Count data were represen-ted as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher's exact probability. Comparison of ordinal data was conducted using the rank sum test. Comparison of visual analog scores was analyzed using generalized estimating equations. Results:(1) Grouping of the enrolled patients. A total of 320 patients with colon cancer were screened for eligibility, including 156 males and 164 females, aged 68(59,73)years. All the 320 patients were allocated into the mesenteric fissure non-closure group with 164 cases and the mesenteric fissure closure group with 156 cases. There was no significant difference in the age, body mass index, American Society of Anesthesiologist score, maximum tumor diameter, anastomosis location, anastomosis method, surgical approach, range of lymph node dissection, tumor staging between the two groups ( P>0.05) and there was a significant difference in the sex between them ( P<0.05). (2) Intraoperative conditions. There was no significant difference between the mesenteric fissure closure group and the mesenteric fissure non-closure group in the volume of intraoperative blood loss, operation time, conversion to laparotomy, intraoperative complication ( P>0.05). Three patients in the mesenteric fissure non-closure group were converted to laparotomy. One patient in the mesenteric fissure closure group was converted to laparotomy, and 2 cases with intraoperative complication were mesenteric hematoma. (3) Postoperative conditions. There was no significant difference between the mesenteric fissure non-closure group and the mesenteric fissure closure group in the overall postoperative complications ( χ2=0.28, P>0.05). There was no significant difference in the occurrence of postoperative intestinal obstruction, abdominal distension, ascites, pleural effusion, gastric paralysis, anastomotic bleeding, anastomotic leakage, or surgical wound infection between the two groups ( P>0.05). There was no significant difference between the two groups in the reoperation, postoperative gastric tube replacement. There was no significant differ-ence in time to postoperative first flatus, time to postoperative initial liquid food intake, time to post-operative resumption of bowel movements, duration of postoperative hospital stay, total hospital expenses between the two groups ( Z=-0.01, 0.43, 1.04, -0.54, -0.36, P>0.05). One patient in the mesenteric fissure non-closure group received reoperation. No perioperative internal hernia or death occurred in either group. The visual analog score decreased with time in both groups. There was no significant difference in the visual analog score between the mesenteric fissure closure group and the mesenteric fissure non-closure group [ β=-0.20(-0.53,0.13), P>0.05]. Conclusion:Compared with closure of mesenteric fissure, non-closure of mesenteric fissure during laparoscopic right hemi-colectomy dose not increase perioperative complications or postoperative management risk.

Objective:To investigate the efficacy and safety of ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors.Methods:A retrospective study was conducted on 106 patients who underwent laparoscopic gastrointestinal tumor surgery in Rugao Branch of Affiliated Hospital of Nantong University from January 2020 to December 2022, 53 patients(observation group) were given the ultrasound-guided of lumbar square muscle block on the arcuate ligament before general anesthesia, 53 patients(control group) were given only general anesthesia. The sensory block planes were recorded at 5 min and 15 min after the block in the observation group, and the hemodynamic indexes, stress indexes at differences time points and postoperative analgesia were compared between the two groups.Results:Most patients in the observation group could monitor the T 8 - L 1 sensory block plane at 5 min after block, and the T 5 - L 2 sensory block plane could be reached at 15 min after block, and the percentage of block was 100.00%(53/53). The results of repeated measurement variance analysis (ANOVA) showed that the intergroup - time point interaction of heart rate (HR) and mean arterial pressure (MAP) between the two groups had statistical differences ( P<0.05); the intergroup-time point interaction of the levels of noradrenaline (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), cortisol (Cor) between the two groups had statistical differences ( P<0.05); the intergroup - time point interaction of the resting and active visual analog scale (VAS) scores between the two groups had statistical differences ( P<0.05). The amount of propofol, remifentanil, the number of effective patient-controlled intravenous analgesia (PCIA) compressions, and the total number of PCIA compressions in the observation group were lower than those in the control group: (1 128.36 ± 137.95) mg vs. (1 415.18 ± 153.24) mg, (1.47 ± 0.49) mg vs. (2.76 ± 0.74) mg, (4.25 ± 0.87) times vs. (8.63 ± 0.94) times, (10.27 ± 1.25) times vs. (15.75 ± 1.47) times, there were statistical differences ( P<0.05). The rate of remedial analgesia within 48 h after surgery between the two groups had no statistical difference ( P>0.05). The awakening time, first time out of bed, first time exhaust and hospitalization time in the observation group were shorter than those in the control group: (4.75 ± 0.57) min vs. (7.02 ± 0.64) min, (11.65 ± 1.47) h vs. (15.87 ± 1.94) h, (14.79 ± 2.12) h vs. (19.59 ± 3.30) h, (4.78 ± 0.72) d vs. (7.14 ± 0.98) d, there were statistical differences ( P<0.05). The incidence of adverse reactions between the two groups had no statistical difference ( P>0.05). Conclusions:Ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors has significant analgesic effects, can reduce intraoperative anesthetic maintenance dose, maintain intraoperative hemodynamic stability, reduce postoperative pain sensation and stress response, reduce postoperative analgesic injection dose, shorten postoperative wakefulness time, and accelerate recovery.

Objective:To detect the incidence of muscle mass loss in the adults and explore its relevant influencing factors.Methods:A total of 1 503 participants aged between 18 and 65 years old were collected from the Department of Preventive Treatment of Disease and Health Management Center of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from March 2019 to October 2021. All subjects completed physical and laboratory examination and bioelectrical impedance analysis. According to the cutpoint of plasma triglycerides concentration≥1.7 mmol/L, waist circumference≥85 cm in men or≥80 cm in women, 1 503 subjects were divided into four groups: normal triglycerides and waist circumference group, normal waist circumference and hypertriglyceridemia group, abdominal obesity and normal triglycerides group, and hypertriglyceridemic-waist phenotype(HTWC) group. Subjects were also divided into 4 groups according to age. Skeletal muscle mass index(ASMI) was calculated according to the skeletal muscle mass of the limbs. Differences of the ASMI and other relevant indicators among the above four groups were analyzed, and body composition was compared among four age groups. Then explore whether HTWC phenotype was an independent risk factor for the occurrence of sarcopenia in different age groups of different gender.Results:The level of triglycerides, fasting blood glucose, systolic blood pressure, and diastolic blood pressure in HTWC group were higher than those in the normal group(all P<0.001). But the incidence of the muscle mass loss in the HTWC group was much lower than that in the other three groups( P<0.001). The incidence of muscle mass loss in overall subjects was 9.2%, in which man was 2.05 times higher than women(12.9% vs 6.3%). There is no statistically significant difference in the incidence of muscle mass loss between the 18-35 age group and the 56-65 age group. Multivariate logistic regression analysis revealed that body mass index, body fat percentage, bone mineral content were independent factors affecting muscle loss in 18-45 year-old adults. After adjustment for other risk factors, HTWC phenotype was still not an independent influencing factor of sarcopenia( OR=1.679, 95% CI 0.523-5.386, P=0.384). Conclusion:HTWC phenotype was not an independent influencing factor of sarcopenia. To prevent the occurrence of sarcopenia in middle-aged and young adults, in addition to assessing the muscle mass, attention should also be given to the measurement of body mass index, bone mineral content, and body fat percentage.

Objective:To investigate the diagnosis, treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations (CCM).Methods:The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad.Results:A total of 10 flying personnel, all male, 20-41 years old, with an average age of 28.3 years, including 8 pilots, 2 air combat/technical personnel, with the flying hours of 110-4 000 h and the average flying hours of 1 102.0 h. The sizes of lesions were 3-12 mm, including 2 cases were smaller than 5 mm, 6 cases were 5-10 mm and 2 cases were bigger than 10 mm. All lesions were located under the cortex, including a case of occipital lobe, 4 cases of frontal lobe, 2 cases of temporal lobe and 3 cases of cerebellar hemisphere. Among the 10 flying personnel, only a case presented intracranial haemorrhage (right cerebellar hemisphere) as first symptom and was treated surgically. Three cases were temporarily grounded due to they were under the grounding observation. Other 7 flying personnel had been followed up for more than 6 months. Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities. Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot, and 2 dual-seat fighter pilots were qualified (limited to dual-seat fighter) and flight-qualified respectively. Two fighter pilots were qualified for lower performance aircraft (limited to bomber, transporter or helicopter).Conclusions:For CCM military flying personnel, the aeromedical assessment conclusion should be made according to the symptoms, lesion location and size, inflight incapacitation possibility assessment, treatment effect, ground observation and follow-up results, as well as the aircraft type and occupation.

Objective:To investigate the diagnosis, treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations (CCM).Methods:The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad.Results:A total of 10 flying personnel, all male, 20-41 years old, with an average age of 28.3 years, including 8 pilots, 2 air combat/technical personnel, with the flying hours of 110-4 000 h and the average flying hours of 1 102.0 h. The sizes of lesions were 3-12 mm, including 2 cases were smaller than 5 mm, 6 cases were 5-10 mm and 2 cases were bigger than 10 mm. All lesions were located under the cortex, including a case of occipital lobe, 4 cases of frontal lobe, 2 cases of temporal lobe and 3 cases of cerebellar hemisphere. Among the 10 flying personnel, only a case presented intracranial haemorrhage (right cerebellar hemisphere) as first symptom and was treated surgically. Three cases were temporarily grounded due to they were under the grounding observation. Other 7 flying personnel had been followed up for more than 6 months. Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities. Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot, and 2 dual-seat fighter pilots were qualified (limited to dual-seat fighter) and flight-qualified respectively. Two fighter pilots were qualified for lower performance aircraft (limited to bomber, transporter or helicopter).Conclusions:For CCM military flying personnel, the aeromedical assessment conclusion should be made according to the symptoms, lesion location and size, inflight incapacitation possibility assessment, treatment effect, ground observation and follow-up results, as well as the aircraft type and occupation.

Objective To study the ambient radiation of patients undergoing ¹⁸F-FDG PET/CT myocardial metabolism imaging, and to provide data for protection of surrounding people against radiation. Methods A total of 33 patients were selected for ¹⁸F-FDG PET/CT myocardial metabolism imaging. Dose equivalent rate was measured at the height of patient chest, in different directions, at different time points and at different distances, to investigate the distribution of ambient radiation of the patient. Results At the same time point and distance, the dose equivalent rates at the left and right sides of the patient were lower than the front and back sides. The dose equivalent rate at 1 m in front of the patient was 13-21 μSv/h after ¹⁸F-FDG injection, and decreased to 5-14 μSv/h after PET/CT imaging, with a mean decrease of 46%. The ambient dose equivalent rate decreased exponentially with distance (10~300 cm), and the mean power was −1.2. Conclusion The ambient radiation of patients undergoing ¹⁸F-FDG PET/CT myocardial metabolism imaging was high after ¹⁸F-FDG injection, and the ambient dose equivalent rate decreased rapidly with time and distance. Our results suggest that patients undergoing myocardial metabolism imaging should avoid prolonged and close contact with other people on the day of examination.