Simultaneous management of intestinal mucosal barrier dysfunction and gut microbiota dysregulation represents a significant challenge in the treatment of inflammatory bowel disease (IBD). Herein, we report a novel system that integrates multi-enzyme mimicking cerium single-atom nanocatalysts (CeSACs) with Lactobacillus reuteri probiotics (LR@CeSACs) for multipronged management of IBD. In this system, CeSACs demonstrate robust multi-enzyme activities across a broad pH range, effectively scavenging elevated reactive oxygen species, downregulating pro-inflammatory cytokines, and suppressing the expression of fibrosis-related genes. Moreover, probiotics promote the targeting and retention of the CeSACs for sustained catalytic antioxidant therapy. In turn, the inflammation relief enabled by CeSACs promotes bacterial viability, allowing for the rapid reshaping of intestinal barrier function and the restoration of gut microbiota. Therefore, LR@CeSACs exhibit excellent catalytic anti-inflammatory and anti-fibrotic therapeutic effects, as well as a certain prophylactic effect, as demonstrated in several murine models.

Objective:To investigate the early right heart function management strategy and prognosis after left ventricular assist device(LVAD) implantation in patients with preoperative right ventricular dysfunction.Methods:A retrospective study was conducted. From March 2022 to April 2024, a total of 28 patients with end-stage heart failure underwent LVAD implantation at Nanjing First Hospital and were admitted to the intensive care unit(ICU) after surgery. Among them, patients with preoperative right ventricular dysfunction were enrolled. All patients were implanted with Corheart 6 implantable left ventricular assist device. The clinical data, occurrence of postoperative right heart failure and postoperative survival situations of enrolled patients were collected and analyzed.Results:A total of 12 patients were included in this study, including 11 males and 1 female, the mean age was(58.4±7.6) years old. Upon postoperative admission to ICU, the most commonly used positive inotropic agent was epinephrine(9 cases), followed by dobutamine(8 cases). By the second day after surgery, the most frequently utilized vasoactive medications were epinephrine and phosphodiesterase type Ⅲ inhibitors, both with 9 cases of usage. None of the enrolled patients utilized temporary mechanical circulatory assist devices. The LVAD pump speed of the patients enrolled in the study was set at approximately 2 700 revolutions per minute, and the pump flow was approximately 3 liters per minute. During the first two days after the operation, the fluid balance of the enrolled patients ranged from(-523.4±775.6)ml to(-1 248.0±1 023.9)ml. At 48 h following the operation, the mean pulmonary artery pressure(MPAP)[(26.2±4.8) mmHg vs.(32.1±6.5) mmHg(1 mmHg=0.133 kPa), P=0.042] and the pulmonary artery wedge pressure(PAWP)[(15.6±5.5)mmHg vs.(24.9±5.9) mmHg, P=0.003) ] of the enrolled patients were significantly decreased compared to preoperative levels, while the cardiac index(CI) was significantly improved[(2.7±0.2)L·min -1·m -2 vs.(2.1±0.5)L·min -1·m -2,P=0.024]. Echocardiography showed that the left atrial diameter(LAD)[(51.5±7.6)mm vs.(57.2±9.0)mm, P=0.005] and left ventricular end diastolic diameter(LVDd)[(73.5±11.5)mm vs.(78.3 ± 12.3)mm, P=0.012) ] were significantly reduced post LVAD implantation as compared to before LVAD implantation, while there was no significant difference in tricuspid annular plane systolic excusion(TAPSE). Postoperative total bilirubin(TBIL) decreased significantly compared to preoperative levels[(15.5±5.0)μmol/L vs.(27.5±17.0)μmol/L, P=0.038]. Three patients experienced right heart failure after the LVAD implantation, with an incidence rate of 25%. Nevertheless, the right heart failure was rectified during the ICU treatment period. The mean ICU treatment time for all enrolled patients was(8.6±2.9) days, the average postoperative hospital stay was(24.3±4.8) days. All enrolled patients survived at 3 months after LVAD implantation. Conclusion:Despite the presence of right ventricular dysfunction in patients before LVAD implantation, with strict fluid management, reasonable LVAD parameters, and appropriate vasoactive drugs, they are able to smoothly pass through the perioperative period, achieve the goals of left ventricular decompression, increase cardiac output, improve perfusion of the end organs, and obtain favorable short-term therapeutic effects.

Insomnia is a prevalent disorder characterized by difficulties in falling asleep or maintaining sleep.Chronic insomnia can severely impair physical and mental health,as well as quality of life.The traditional Chinese medicine(TCM)theory,"all the eleven zang organs depend on the gallbladder,"is derived from the chapter of Discussion on Six-Plus-Six System and the Manifestations of Organs of Plain Questions.It highlights the pivotal role of the gallbladder in maintaining visceral function.The gallbladder governs decision-making and plays a central role in sleep regulation by modulating spleen-stomach transportation and transformation,dispersing qi movement throughout the body,harmonizing yin and yang,and modulating ying and wei systems.Research has demonstrated that bile acids correspond closely with the gallbladder's TCM functions of"governing the earth zang"and"regulating the eleven zang organs,"serving as a crucial material basis for gallbladder physiology.Dysregulation of bile acid metabolism may contribute to insomnia through multiple pathways,including gastrointestinal dysfunction,disruption of gut microbiota balance,induction of neuroinflammation,and circadian rhythm disturbances.This study proposes that bile acid metabolism disorder may constitute a key pathological mechanism linking gallbladder dysfunction—according to TCM theory—to insomnia.Based on clinical experience,novel therapeutic strategies are proposed under the framework of"regulating the gallbladder to tranquilize mind",including the use of gallbladder-related materials,prioritized application of liver-regulating herbs,and implementation of a sleep rhythm reconstruction protocol.

Insomnia is a prevalent disorder characterized by difficulties in falling asleep or maintaining sleep.Chronic insomnia can severely impair physical and mental health,as well as quality of life.The traditional Chinese medicine(TCM)theory,"all the eleven zang organs depend on the gallbladder,"is derived from the chapter of Discussion on Six-Plus-Six System and the Manifestations of Organs of Plain Questions.It highlights the pivotal role of the gallbladder in maintaining visceral function.The gallbladder governs decision-making and plays a central role in sleep regulation by modulating spleen-stomach transportation and transformation,dispersing qi movement throughout the body,harmonizing yin and yang,and modulating ying and wei systems.Research has demonstrated that bile acids correspond closely with the gallbladder's TCM functions of"governing the earth zang"and"regulating the eleven zang organs,"serving as a crucial material basis for gallbladder physiology.Dysregulation of bile acid metabolism may contribute to insomnia through multiple pathways,including gastrointestinal dysfunction,disruption of gut microbiota balance,induction of neuroinflammation,and circadian rhythm disturbances.This study proposes that bile acid metabolism disorder may constitute a key pathological mechanism linking gallbladder dysfunction—according to TCM theory—to insomnia.Based on clinical experience,novel therapeutic strategies are proposed under the framework of"regulating the gallbladder to tranquilize mind",including the use of gallbladder-related materials,prioritized application of liver-regulating herbs,and implementation of a sleep rhythm reconstruction protocol.

Objective:To investigate the early right heart function management strategy and prognosis after left ventricular assist device(LVAD) implantation in patients with preoperative right ventricular dysfunction.Methods:A retrospective study was conducted. From March 2022 to April 2024, a total of 28 patients with end-stage heart failure underwent LVAD implantation at Nanjing First Hospital and were admitted to the intensive care unit(ICU) after surgery. Among them, patients with preoperative right ventricular dysfunction were enrolled. All patients were implanted with Corheart 6 implantable left ventricular assist device. The clinical data, occurrence of postoperative right heart failure and postoperative survival situations of enrolled patients were collected and analyzed.Results:A total of 12 patients were included in this study, including 11 males and 1 female, the mean age was(58.4±7.6) years old. Upon postoperative admission to ICU, the most commonly used positive inotropic agent was epinephrine(9 cases), followed by dobutamine(8 cases). By the second day after surgery, the most frequently utilized vasoactive medications were epinephrine and phosphodiesterase type Ⅲ inhibitors, both with 9 cases of usage. None of the enrolled patients utilized temporary mechanical circulatory assist devices. The LVAD pump speed of the patients enrolled in the study was set at approximately 2 700 revolutions per minute, and the pump flow was approximately 3 liters per minute. During the first two days after the operation, the fluid balance of the enrolled patients ranged from(-523.4±775.6)ml to(-1 248.0±1 023.9)ml. At 48 h following the operation, the mean pulmonary artery pressure(MPAP)[(26.2±4.8) mmHg vs.(32.1±6.5) mmHg(1 mmHg=0.133 kPa), P=0.042] and the pulmonary artery wedge pressure(PAWP)[(15.6±5.5)mmHg vs.(24.9±5.9) mmHg, P=0.003) ] of the enrolled patients were significantly decreased compared to preoperative levels, while the cardiac index(CI) was significantly improved[(2.7±0.2)L·min -1·m -2 vs.(2.1±0.5)L·min -1·m -2,P=0.024]. Echocardiography showed that the left atrial diameter(LAD)[(51.5±7.6)mm vs.(57.2±9.0)mm, P=0.005] and left ventricular end diastolic diameter(LVDd)[(73.5±11.5)mm vs.(78.3 ± 12.3)mm, P=0.012) ] were significantly reduced post LVAD implantation as compared to before LVAD implantation, while there was no significant difference in tricuspid annular plane systolic excusion(TAPSE). Postoperative total bilirubin(TBIL) decreased significantly compared to preoperative levels[(15.5±5.0)μmol/L vs.(27.5±17.0)μmol/L, P=0.038]. Three patients experienced right heart failure after the LVAD implantation, with an incidence rate of 25%. Nevertheless, the right heart failure was rectified during the ICU treatment period. The mean ICU treatment time for all enrolled patients was(8.6±2.9) days, the average postoperative hospital stay was(24.3±4.8) days. All enrolled patients survived at 3 months after LVAD implantation. Conclusion:Despite the presence of right ventricular dysfunction in patients before LVAD implantation, with strict fluid management, reasonable LVAD parameters, and appropriate vasoactive drugs, they are able to smoothly pass through the perioperative period, achieve the goals of left ventricular decompression, increase cardiac output, improve perfusion of the end organs, and obtain favorable short-term therapeutic effects.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

miR-135 is a highly conserved miRNA in mammals and includes miR-135a and miR-135b.Recent studies have shown that miR-135b is a key regulatory factor in cardio-cerebrovascular diseases.It is involved in regulating the pathological process of myocardial infarction,myocardial ischemia/reperfusion injury,cardiac hypertrophy,atrial fibrillation,diabetic cardiomyopathy,atherosclerosis,pulmonary hyperten-sion,cerebral ischemia/reperfusion injury,Parkinson's disease,and Alzheimer's disease.Obviously,miR-135b is an emerging player in cardio-cerebrovascular diseases and is expected to be an important target for the treatment of cardio-cerebrovascular diseases.However,the crucial role of miR-135b in cardio-cerebrovascular diseases and its underlying mechanism of action has not been reviewed.Therefore,in this review,we aimed to comprehensively summarize the role of miR-135b and the signaling pathway mediated by miR-135b in cardio-cerebrovascular diseases.Drugs targeting miR-135b for the treatment of diseases and related patents,highlighting the importance of this target and its utility as a therapeutic target for cardio-cerebrovascular diseases,have been discussed.

Objective To investigate the efficacy and safety of camrelizumab monoclonal antibody combined with molecular-targeted therapy in elderly patients with unresectable or advanced hepatocellular carcinoma(HCC).Methods A retrospective analysis was performed for the patients with unresectable/advanced HCC who attended six hospitals from January 1,2019 to March 31,2021,and all patients received camrelizumab monoclonal antibody treatment,among whom 84.8%also received targeted therapy.According to the age of the patients,they were divided into elderly group(≥65 years)and non-elderly group(＜65 years).The two groups were assessed in terms of overall survival(OS),progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR),and immune-related adverse events(irAE).The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups;the independent samples t-test was used for comparison of normally distributed continuous data,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The Kaplan-Meier method was used for survival analysis,and the log-rank test was used for comparison of survival curves.Univariate and multivariate Cox proportional hazards regression analyses were used to determine the independent influencing factors for PFS and DCR at 6 months.Results A total of 99 HCC patients were enrolled,with 27 in the elderly group and 72 in the non-elderly group.The elderly group had an OS rate of 67.8%,an ORR of 44.4%,and a DCR of 74.1%at 12 months and a median PFS of 6.4(95%confidence interval[CI]:3.0-12.4)months,with no significant differences compared with the non-elderly group(all P＞0.05).The median OS was unavailable for the elderly group,while the non-elderly group had an OS of 18.9(95%CI:13.0-24.8)months;there was no significant difference between the two groups(P=0.485).The univariate and multivariate Cox regression analyses showed that major vascular invasion(MVI)was an independent risk factor for PFS(hazard ratio[HR]=2.603,95%CI:1.136-5.964,P=0.024)and DCR(HR=3.963,95%CI:1.671-9.397,P=0.002)at 6 months,while age,sex,etiology of HBV infection,presence of extrahepatic metastasis,Child-Pugh class B,and alpha-fetoprotein＞400 ng/mL were not associated with PFS or DCR at 6 months.For the elderly group,the incidence rates of any irAE and grade 3/4 irAE were 51.9%and 25.9%,respectively,with no significant differences compared with the non-elderly group(P＞0.05),and skin disease was the most common irAE in both groups(39.4%).Conclusion Camrelizumab monoclonal antibody combined with molecular-targeted therapy has similar efficacy and safety in patients with unresectable/advanced HCC aged≥65 years and those aged＜65 years.MVI is associated with suboptimal response to immunotherapy and poor prognosis.

Objective:To assess the pharmacoeconomic implications of injectable cefuroxime sodium acquired through centralized bulk purchasing versus importation for perioperative prophylaxis in obstetrics and gynecology. Methods:A retrospective cohort study was conducted involving 408 patients treated at the Department of Obstetrics and Gynecology at Jiaxing Maternity and Child Health Care Hospital from January to December 2021. The patients were divided into two groups based on the type of perioperative antimicrobial agents used: the importation group and the centralized bulk purchasing group. Propensity score matching was used to balance confounding factors. Postoperative clinical infection indicators, maximum body temperature, length of hospital stay, and incidence of postoperative infections were compared between the two groups. Additionally, a cost-effectiveness analysis was performed.Results:After propensity score matching, a total of 132 patients were successfully matched. In the centralized bulk purchasing group, the length of hospital stay, first postoperative white blood cell count, maximum body temperature, and overall prophylactic effectiveness rate were (6.12 ± 0.28) days, (8.40 ± 0.56) × 10 9/L, (37.16 ± 0.04) °C, and 93.9% (124/132), respectively. In comparison, the corresponding values in the importation group were (6.21 ± 0.16) days, (7.83 ± 0.44) × 10 9/L, (37.16 ± 0.03) °C, and 95.5% (126/132). The differences in these measurements between the two groups were not statistically significant ( t = -0.28, 0.80, 0.02, χ2 = 0.30, all P > 0.05). In the centralized bulk purchasing group, the antimicrobial drug cost was 50.70 (33.80, 67.60) yuan, and the total cost of Western medicine was (831.41 ± 39.13) yuan. Both of these costs were significantly lower than those in the importation group [70.48 (35.24, 105.72) yuan, (975.98 ± 46.35) yuan, Z = -7.70, t = -2.38, both P < 0.05]. The cost-effectiveness ratio of the centralized bulk purchasing group and the importation group was 0.54 and 8.85, respectively, which were lower than those in the importation group (0.74, 10.22). Using the prevention effectiveness of the centralized bulk purchasing group as a baseline, every 1% increase in prevention effectiveness in the importation group resulted in additional costs of 12.36 yuan for antimicrobial drugs and 90.36 yuan for total Western medicine. Conclusion:Injectable cefuroxime sodium acquired through both centralized bulk purchasing and importation is highly effective in preventing postoperative infections in obstetrics and gynecology. A cost-effectiveness analysis shows that the injectable cefuroxime sodium obtained through centralized bulk purchasing is more cost-effective than the imported approach, resulting in greater economic benefits.

Objective:To assess the pharmacoeconomic implications of injectable cefuroxime sodium acquired through centralized bulk purchasing versus importation for perioperative prophylaxis in obstetrics and gynecology. Methods:A retrospective cohort study was conducted involving 408 patients treated at the Department of Obstetrics and Gynecology at Jiaxing Maternity and Child Health Care Hospital from January to December 2021. The patients were divided into two groups based on the type of perioperative antimicrobial agents used: the importation group and the centralized bulk purchasing group. Propensity score matching was used to balance confounding factors. Postoperative clinical infection indicators, maximum body temperature, length of hospital stay, and incidence of postoperative infections were compared between the two groups. Additionally, a cost-effectiveness analysis was performed.Results:After propensity score matching, a total of 132 patients were successfully matched. In the centralized bulk purchasing group, the length of hospital stay, first postoperative white blood cell count, maximum body temperature, and overall prophylactic effectiveness rate were (6.12 ± 0.28) days, (8.40 ± 0.56) × 10 9/L, (37.16 ± 0.04) °C, and 93.9% (124/132), respectively. In comparison, the corresponding values in the importation group were (6.21 ± 0.16) days, (7.83 ± 0.44) × 10 9/L, (37.16 ± 0.03) °C, and 95.5% (126/132). The differences in these measurements between the two groups were not statistically significant ( t = -0.28, 0.80, 0.02, χ2 = 0.30, all P > 0.05). In the centralized bulk purchasing group, the antimicrobial drug cost was 50.70 (33.80, 67.60) yuan, and the total cost of Western medicine was (831.41 ± 39.13) yuan. Both of these costs were significantly lower than those in the importation group [70.48 (35.24, 105.72) yuan, (975.98 ± 46.35) yuan, Z = -7.70, t = -2.38, both P < 0.05]. The cost-effectiveness ratio of the centralized bulk purchasing group and the importation group was 0.54 and 8.85, respectively, which were lower than those in the importation group (0.74, 10.22). Using the prevention effectiveness of the centralized bulk purchasing group as a baseline, every 1% increase in prevention effectiveness in the importation group resulted in additional costs of 12.36 yuan for antimicrobial drugs and 90.36 yuan for total Western medicine. Conclusion:Injectable cefuroxime sodium acquired through both centralized bulk purchasing and importation is highly effective in preventing postoperative infections in obstetrics and gynecology. A cost-effectiveness analysis shows that the injectable cefuroxime sodium obtained through centralized bulk purchasing is more cost-effective than the imported approach, resulting in greater economic benefits.