OBJECTIVE To investigate the mechanism by which Shenfukang capsule （SFK） ameliorates renal interstitial fibrosis （RIF） by regulating macrophage-fibroblast crosstalk via the signal transducer and activator of transcription 3 （STAT3）/Yes-associated protein （YAP） pathway. METHODS RAW264.7 macrophages were induced to polarize with transforming growth factor-β 1 （TGF-β 1 ）. Subsequently， a non-contact co-culture system of macrophages with renal fibroblasts NRK-49F， as well as a non-contact co-culture system of macrophages with YAP-knockdown renal fibroblasts， were established. Cells were treated with low， medium， and high concentrations （4， 8， 16 μg/mL） of SFK， as well as a STAT3 inhibitor （STAT3-I，1.64 μg/mL） and losartan potassium tablets （positive control， 0.28 μg/mL）， for 48 h. After intervention， the protein and mRNA expression levels of CD86， CD163， and STAT3 in macrophages， as well as CD86， F4/80， and STAT3 mRNA， were detected. In co-cultured renal fibroblasts， the protein and mRNA expression levels of α -smooth muscle actin （ α -SMA）， Vimentin， collagen type Ⅰ （Col-Ⅰ）， matrix metalloproteinase-1 （MMP-1）， and YAP were detected. In co-cultured YAP-knockdown renal fibroblasts， the protein and mRNA expression levels of α -SMA， Vimentin， and MMP-1 were also detected. RESULTS Following TGF-β 1 induction， the protein expression levels of CD86， CD163， and STAT3， as well as the mRNA expression levels of CD86， F4/80， and STAT3 in macrophages were significantly increased （ P ＜0.05）. The conditioned medium from polarized macrophages activated renal fibroblasts， as evidenced by significantly increased protein and mRNA expression levels of α -SMA， Vimentin， Col-Ⅰ， and YAP， and significantly decreased protein and mRNA expression levels of MMP-1 in renal fibroblasts （ P ＜0.05）. Treatment with SFK and STAT3-I reversed the changes in the above indicators， with the medium concentration SFK group showing stronge r effects on some indicators than the low and high concentration groups. In the non-contact co-culture experiment of macrophages and YAP-knockdown renal fibroblasts， there were no statistically significant differences in the protein and mRNA expression of α-SMA， Vimentin， and MMP-1 among the groups. CONCLUSIONS SFK can inhibit macrophage-renal fibroblast crosstalk by blocking the STAT3/YAP pathway， thereby delaying the progression of RIF.

OBJECTIVE To explore the influencing factors of Shenfukang capsule in the treatment of chronic kidney disease （CKD） and construct a nomogram prediction model for evaluating its therapeutic efficacy. METHODS CKD patients who were hospitalized from July 2019 to August 2022 in the First Affiliated Hospital of Guangxi Medical University and treated with Shenfukang capsule were selected as study subjects. Clinical data of the patients were collected from the hospital’s electronic medical record system， and they were divided into an effective group and an ineffective group based on treatment outcomes. Lasso-Logistic multivariate regression analysis was used to screen the influencing factors of the efficacy of Shenfukang capsule. Using the effectiveness of Shenfukang capsule treatment as the prediction outcome and the screened influencing factors as predictor variables， a nomogram prediction model was constructed using R software. All patients were randomly divided into a training cohort and a validation cohort. The discriminative ability， calibration， and clinical net benefit of the model were evaluated using the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis， respectively. RESULTS Lasso-Logistic regression analysis revealed that concurrent diabetes mellitus， decreased levels of blood urea nitrogen， triglycerides， and serum phosphorus， as well as prolonged prothrombin time and elevated apolipoprotein AⅠ levels， were influencing factors for reduced efficacy of Shenfukang capsule in CKD treatment. The evaluation results of the nomogram prediction model showed that the area under curve values were 0.745 and 0.797 in the training and validation cohorts， respectively， which were close and both exceeded 0.70， indicating stable predictive performance. The calibration curves demonstrated good agreement in both datasets， suggesting satisfactory calibration performance. The clinical decision curves were positioned above the two extreme reference lines， indicating high clinical benefit of the model. CONCLUSIONS Diabetes mellitus， blood urea nitrogen， triglycerides， apolipoprotein AⅠ， serum phosphorus， and prothrombin time were factors associated with the efficacy of Shenfukang capsule in CKD patients. The nomogram prediction model established in this study may provide a basis for rational clinical application of Shenfukang capsule and for improving its therapeutic efficacy in CKD.

OBJECTIVE To explore the influencing factors of Shenfukang capsule in the treatment of chronic kidney disease （CKD） and construct a nomogram prediction model for evaluating its therapeutic efficacy. METHODS CKD patients who were hospitalized from July 2019 to August 2022 in the First Affiliated Hospital of Guangxi Medical University and treated with Shenfukang capsule were selected as study subjects. Clinical data of the patients were collected from the hospital’s electronic medical record system， and they were divided into an effective group and an ineffective group based on treatment outcomes. Lasso-Logistic multivariate regression analysis was used to screen the influencing factors of the efficacy of Shenfukang capsule. Using the effectiveness of Shenfukang capsule treatment as the prediction outcome and the screened influencing factors as predictor variables， a nomogram prediction model was constructed using R software. All patients were randomly divided into a training cohort and a validation cohort. The discriminative ability， calibration， and clinical net benefit of the model were evaluated using the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis， respectively. RESULTS Lasso-Logistic regression analysis revealed that concurrent diabetes mellitus， decreased levels of blood urea nitrogen， triglycerides， and serum phosphorus， as well as prolonged prothrombin time and elevated apolipoprotein AⅠ levels， were influencing factors for reduced efficacy of Shenfukang capsule in CKD treatment. The evaluation results of the nomogram prediction model showed that the area under curve values were 0.745 and 0.797 in the training and validation cohorts， respectively， which were close and both exceeded 0.70， indicating stable predictive performance. The calibration curves demonstrated good agreement in both datasets， suggesting satisfactory calibration performance. The clinical decision curves were positioned above the two extreme reference lines， indicating high clinical benefit of the model. CONCLUSIONS Diabetes mellitus， blood urea nitrogen， triglycerides， apolipoprotein AⅠ， serum phosphorus， and prothrombin time were factors associated with the efficacy of Shenfukang capsule in CKD patients. The nomogram prediction model established in this study may provide a basis for rational clinical application of Shenfukang capsule and for improving its therapeutic efficacy in CKD.

This article reported a pregnant woman admitted to the hospital due to "25 +2 weeks of amenorrhea and a 1-day history of shortened cervical canal accompanied by vaginal bleeding". The patient with pregestational diabetes mellitus and suboptimal glycemic control required prolonged hospitalization for tocolytic therapy due to shortened cervical length. She developed a cough at 31 weeks and 4 days of gestation, followed by right-sided intercostal pain and hypotension after coughing at 31 weeks and 6 days of gestation. Bedside chest ultrasound showed a small anechoic fluid collection (approximately 1.1 cm in width) in the right pleural cavity. The emergency cesarean section was performed at 31 weeks and 4 days of gestation. However, the intraoperative bleeding and other conditions were inconsistent with the obstetric clinical presentations of blood loss. Subsequent repeated ultrasound and CT examinations confirmed the diagnosis of pulmonary sequestration and right-sided progressive hemopneumothorax. On the same day, an emergency right lower lobectomy was performed, achieving stable postoperative recovery. Both mother and infant had favorable outcomes. Hemopneumothorax complicated by pulmonary sequestration is uncommon, and its occurrence during pregnancy is exceedingly rare. Multidisciplinary consultations, aggressive, rapid, and accurate diagnosis, and combined treatment are critical to ensuring maternal-fetal survival. Hemopneumothorax caused by the rupture of pulmonary sequestration during pregnancy represents a life-threatening condition. Emergency thoracotomy can timely clarify the cause, arrest bleeding, relieve compression, and resect the lesion, thereby reducing mortality and the complications risk.

This article reported a pregnant woman admitted to the hospital due to "25 +2 weeks of amenorrhea and a 1-day history of shortened cervical canal accompanied by vaginal bleeding". The patient with pregestational diabetes mellitus and suboptimal glycemic control required prolonged hospitalization for tocolytic therapy due to shortened cervical length. She developed a cough at 31 weeks and 4 days of gestation, followed by right-sided intercostal pain and hypotension after coughing at 31 weeks and 6 days of gestation. Bedside chest ultrasound showed a small anechoic fluid collection (approximately 1.1 cm in width) in the right pleural cavity. The emergency cesarean section was performed at 31 weeks and 4 days of gestation. However, the intraoperative bleeding and other conditions were inconsistent with the obstetric clinical presentations of blood loss. Subsequent repeated ultrasound and CT examinations confirmed the diagnosis of pulmonary sequestration and right-sided progressive hemopneumothorax. On the same day, an emergency right lower lobectomy was performed, achieving stable postoperative recovery. Both mother and infant had favorable outcomes. Hemopneumothorax complicated by pulmonary sequestration is uncommon, and its occurrence during pregnancy is exceedingly rare. Multidisciplinary consultations, aggressive, rapid, and accurate diagnosis, and combined treatment are critical to ensuring maternal-fetal survival. Hemopneumothorax caused by the rupture of pulmonary sequestration during pregnancy represents a life-threatening condition. Emergency thoracotomy can timely clarify the cause, arrest bleeding, relieve compression, and resect the lesion, thereby reducing mortality and the complications risk.

In traditional clinical teaching of impacted tooth extraction, there are problems including limited observation fields for students, insufficient doctor-patient communication training, inadequate clinical thinking development, and low levels of clinical participation. Based on the core elements of visualizing jaw structure with perspective, formulating clinical strategy, immersing in clinical participation, and cultivating the spirit of caregiving, we developed a virtual reality simulation teaching platform for the clinical decision analysis of impacted tooth extraction. The virtual simulation-based platform can create three different impacted tooth scenarios in 3D, which demonstrates the process of clinical decision analysis of impacted tooth extraction through virtuality-reality interaction, allowing students to immerse in the discovery, analysis, and resolution of the medical and humanistic problems in the process of impacted tooth extraction. The questionnaire survey showed that 81.36% (48/59) of the students believed that the software could improve their clinical thinking ability; 76.27% (45/59) of the students believed that it could help them master the basic process of impacted tooth extraction; and 62.71% (37/59) of the students believed that it could improve their skills of impacted tooth extraction. By providing immersive learning experience, constructive teaching design, and multi-dimensional teaching evaluation, the software achieved the goals of cultivating students' clinical thinking ability and professional literacy in oral and maxillofacial surgery.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

OBJECTIVE: To discuss the effects of single dose of cisplatin on renal interstitial fibrosis indicators in rats dynamically. METHODS: 72 SD rats were randomly divided into normal group and cisplatin group, with 36 rats in each group. Normal group and cisplatin group were given equal volume of normal saline and cisplatin 5 mg/kg intraperitoneally on the first day, respectively. Each 6 rats were sacrificed on 8th, 14th, 30th, 50th, 60th, 90th day. The serum levels of blood urea nitrogen (BUN) and creatinine (Cr) were determined, and the degree of renal tubulointerstitial injury and relative area of renal tubulointerstitial fibrosis were evaluated. The expression of α-smooth muscle actin (α-SMA), type Ⅰ collagen (Col Ⅰ) and transforming growth factor β1 (TGF-β1) were determined in renal tissue. RESULTS: Compared with normal group, the serum levels of BUN and Cr, renal tubulointerstitial injury indexes, relative area of renal tubulointerstitial fibrosis, and the expression of α-SMA, Col Ⅰ and TGF-β1 in renal tissue were increased significantly (P<0. 05 or P<0. 01). In cisplatin group, within the 8th-90th days, serum level of BUN in rats had no significant change; serum level of Cr, renal tubulointerstitial injury indexes, renal tubulointerstitial fibrosis, the expression of a-SMA, Col Ⅰ and TGF-β1 in renal tissue increased first and then decreased. CONCLUSIONS: A single dose of clinical dose of cisplatin can induce renal interstitial fibrosis in rats, and its mechanism may be related to the expression of TGF-β1 in renal tissue.

OBJECTIVE:To investigate the effects of Shenfukang capsules on clinical efficacy and renal function indexes of patients with renal insufficiency. METHODS:Totally 100 inpatients with renal insufficiency treated by Shenfukang cap-sules in the First Affiliated Hospital of Guangxi Medical University during Feb. to Mar. 2015 were analyzed retrospectively in respects of general information of patients,therapy plan,renal function indexs before and after treatment and clinical effica-cy. The relationship of clinical efficacy with age and duration was also analyzed. RESULTS:There were 33 cases of acute re-nal insufficiency and 67 cases of chronic renal insufficiency. The route of administration of Shenfukang capsules was oral ad-ministration(97 cases,97.00%),the main dosage was 6 capsule/d(36 cases,36.00%),and treatment duration were 0-<7 days(39 cases)and 7-<15 days(49 cases). After treatment,the average serum creatinine concentration was lower than be-fore treatment,while mean GFR and Ccr were higher than before treatment,with statistical significance(P<0.05). The total response rate was 72.00%,and response rate of patients with acute renal insufficiency was 87.88% and significantly higher than 64.18% of patients with chronic renal insufficiency,with statistical significance(P<0.05). Among patients with ≤60 years old,the total response rate of patients with acute renal insufficiency was significantly higher than that of patients with chronic renal insufficiency,with statistical significance(P<0.05);among patients elder than 60 years old,there was no statistical significance in therapeutic efficacy between acute renal insufficiency and chronic renal insufficiency(P>0.05);among patients with chronic renal insufficiency,the total response rate of patients elder than 60 years old was significantly better than that of patients with ≤60 years old,with statistical significance (P<0.05). With the extension of treatment duration,the total response rate of patients with acute renal insufficiency was on the rise,and that of patients with chron-ic renal insufficiency increased first and then decreased. No obvious ADR was found during treatment. CONCLUSIONS:Shenfu-kang capsules can improve renal function in patients with renal insufficiency,and has definite curative effect on acute and chronic renal insufficiency with good security. The clinical efficacy may be related to age and treatment course.

Objective To explore the changing rule of schistosomiasis endemic situation in Gaoyou City,so as to provide the evidences for schistosomiasis control in lake and marshland regions. Methods The endemic data of schistosomiasis of Gaoy?ou City from 1970 to 2009 were collected to analyze the endemic patterns of schistosomiasis in different control stages compre?hensively. Results In the first years of infection control stage(1970-1975),transmission control stage(1976-1994)and transmission interruption stage(1995-2009),the prevalence rates of schistosomiasis were 4.20%,0.80%and 0 in human and 3.00%,0.51%and 0 in cattle respectively. In 1984,the positive rate of crowd stool tests fell to 0.04%,which was reduced by 99.05%compared with that in 1970. From 1970 to 1980,the positive rates of stool tests of people and livestock were positively correlated significantly(r=0.67,P<0.05). After 1985,no local infection patients or cattle were found. No schistosome infect?ed Oncomelania hupensis snails were found from 1970 to 2009. Conclusion The comprehensive control measures have been insisted in Gaoyou City in different prevention and control stages. Although the snail situation is undulate,the prevalence of schistosomiasis steadily declines and the interruption of transmission has achieved.