"State-target-cause-result"is a new clinical theory combining macroscopic and microscopic syndrome differentiation based on the holistic view of traditional Chinese medicine combined with Western medical research.The"inflammation-cancer transformation"of chronic pancreatitis is a complex pathological process that is associated with the interaction between the pancreas and various pathological factors and multiple objects,involving the imbalance of multiple homeostasis.The microscopic process of"inflammation-cancer transformation"in chronic pancreatitis is the"target,"whereas various factors that could induce its occurrence under chronic inflammatory conditions are the"state."The"inflammation-cancer transformation"of chronic pancreatitis is summarized as yin and yang imbalance,qi movement disorder,endogenous dampness,heat,blood stasis,and turbid phlegm stagnation,unresolved congestion resulting in deficiency caused by stagnation,intermingled deficiency and excess,and internal cancer toxin generation.This paper elucidates the pathogenesis and intervention strategies of the"inflammation-cancer transformation"of chronic pancreatitis from a macro perspective of"state,"focusing on reducing the impact of"state"imbalance on the"target"to establish a balanced pancreas-immune-microbiota state.The aim is to broaden the theory for exploring the mechanism and drug development related to chronic pancreatitis"inflammation-cancer transformation"in both traditional Chinese and Western medicine.

Objective To evaluate the improvement in the quality of early postoperative recovery in patients undergoing cardiac valve surgery with remimazolam-based fast-track anesthesia,and to provide a reference for the clinical optimization of fast-track anesthesia and Enhanced Recovery After Surgery(ERAS)protocols.Methods We selected elective surgery patients undergoing median sternotomy for cardiac valve replacement and/or repair under general anesthesia with extracorporeal circulation.Based on routine anesthesia assessment and fast-track anesthesia suitability assessment,a total of 228 patients were strictly enrolled according to the inclusion and exclusion criteria and randomly divided into two groups:the Remimazolam group(n=114)and the Propofol group(n=114).Patients in the Remimazolam group were induced and maintained with remimazolam for anesthesia,while patients in the control group were administered propofol.We recorded the general information and surgical data of the patients;the QoR-15 scores before surgery(1 day preoperatively),1 day postoperatively,3 days postoperatively,and 1 day before discharge;as well as hemodynamic parameters at key time points after admission,the incidence of hypotension and bradycardia after anesthesia,the duration of surgery,anesthesia duration,postoperative mechanical ventilation time,ICU stay,postoperative hospital stay,and the incidence of perioperative cardiovascular adverse events and the incidence of early postoperative complications.Results There was no statistically significant difference in general data and QoR-15 scores between the two groups 1 day before surgery(P>0.05).The QoR-15 score of the Remima-zolam group 1 day before discharge was higher than that of the Propofol group,with a statistically significant differ-ence(P<0.05),but the difference was less than the minimum clinically important difference,which is less than 8,indicating no significant clinical benefit.One minute after intubation and one minute after skin incision,the heart rate in the Propofol group slowed down and the Mean Arterial Pressure(MAP)significantly decreased,with a statis-tically significant difference between the groups(P<0.05);there was no statistically significant difference in heart rate and MAP at other times.The incidence of intraoperative hypotension and bradycardia was lower in the Remima-zolam group than in the Propofol group,with a statistically significant difference(P<0.05).The duration of postop-erative mechanical ventilation,ICU stay,postoperative hospital stay,and the rate of re-intubation were all shorter in the Remimazolam group than in the Propofol group,and the success rate of fast-track anesthesia was higher in the Remimazolam group,with a statistically significant difference(P<0.05).There was no statistically significant difference in the incidence of perioperative complications between the two groups.Conclusions Compared with the commonly used intravenous anesthetic propofol,the remimazolam-based fast-track anesthesia regimen did not signifi-cantly improve the postoperative recovery quality scores in patients undergoing cardiac valve surgery.However,remimazolam had advantages in maintaining hemodynamic stability,increasing the success rate of fast-track anesthe-sia,shortening postoperative ICU stay and hospital stay,and is a viable intravenous anesthetic option for cardiac surgery patients.

ObjectiveTo investigate the clinical efficacy and safety of Qihuang Jianpi Zishen granules in the treatment of cardiac involvement in systemic lupus erythematosus （SLE）. MethodA total of 62 SLE patients with cardiac involvement treated in the Department of Rheumatology and Immunology， the First Affiliated Hospital of Anhui University of Chinese Medicine from June 2021 to December 2022 were randomized into control and observation groups （n=31）. The control group was treated with methylprednisolone tablets and hydroxychloroquine sulfate tablets， and the observation group with Qihuang Jianpi Zishen granules on the basis of the therapy in the control group. After 12 weeks of treatment， the two groups were compared in terms of the therapeutic effect， cardiac function indicators ［left atrial end-diastolic diameter （LADd）， left ventricular end-diastolic diameter （LVDd）， left ventricular posterior wall thickness （LVPWTd）， peak blood flow velocity in early diastolic period （peak E）， peak blood flow velocity in late diastolic period （peak A）， E/A ratio， stroke volume （SV）， left ventricular ejection fraction （LVEF）， left ventricular short axis shortening rate （LVFS）， and B-type natriuretic peptide （BNP）］， vascular damage indicators ［nitric oxide （NO）， endothelin-1 （ET-1）， vascular endothelial growth factor （VEGF）， and homocysteine （Hcy）］， inflammation indicators ［erythrocyte sedimentation rate （ESR） and hypersensitive C-reactive protein （Hs-CRP）］， anti-double-stranded DNA （dsDNA） antibodies， disease activity index （SLEDAI） score， mitigation of symptoms and signs， and occurrence of adverse reactions. ResultThe total response rate in the observation group was 87.09%， which was higher than that （67.74%） in the control group （P<0.01）， and the incidence of adverse reactions had no significant difference between the two groups. After treatment， the control group showed lowered LVDd， LVPWTd， BNP， ET-1， VEGF， and Hcy （P<0.05） and increased E peak， E/A ratio， SV， LVEF， and LVFS （P<0.05）. In the observation group， LADd， LVDd， LVPWTd， peak A， BNP， NO， ET-1， VEGF， and Hcy decreased （P<0.05）， while peak E， E/A ratio， SV， LVEF and LVFS increased （P<0.05） after treatment. The treatment in both groups decreased the scores of palpitation， chest tightness， dyspnea， and edema （P<0.05）， reduced ESR， Hs-CRP， ds-DNA， and SLEDAI （P<0.05）. After treatment， the observation group had lower LADd， LVDd， LVPWTd， peak A， BNP， and scores of palpation， chest tightness， dyspnea， and edema （P<0.05） and higher peak E， E/A ratio， SV， LVEF， and LVFS （P<0.05） than the control group. In addition， the observation group had lower NO， ET-1， VEGF， Hcy， ESR， Hs-CRP， ds-DNA， and SLEDAI than the control group （P<0.05）. ConclusionQihuang Jianpi Zishen granules combined with hydroxychloroquine sulfate and methylprednisolone can improve multiple indicators and mitigate the symptoms and signs of SLE patients with cardiac involvement， demonstrating a clinical application value.

Objective To explore the value of 8-iso-PG and endothelin (ET-1) detections in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary hypertension (PAH).Methods A total of 40 AECOPD patients with pulmonary hypertension were randomly divided into treatment group and control group,anotheR20 COPD patients without pulmonary hypertension were selected as control group.According to the level of pulmonary arterial pressure,the patients were divided into subgroups,and correlation and changes of indexes were compared among groups.Results There were significant differences between the AECOPD group and combined PAH group in serum 8-iso-PG and endothelin levels (P<0.01).Correlation analysis showed that the levels of 8-iso-PG and ET-1 in the combined PAH group were not correlated with FVC,p(CO2) and FEV1 (P>0.05),but there was a negative lineaRcorrelation with p(O2) and was positively correlated with pulmonary artery pressure (P<0.05).There were significant differences in 8-iso-PG and ET-1 levels among different PAH groups (P<0.01).AfteRtreatment,levels of ET-1 and 8-iso-PG significantly reduced,FEV1 and FVC significantly increased (P<0.05),and the level of PASP reduced significantly in treatment group and control group (P<0.05).Conclusion 8-iso-PG can be used as a good markeRof oxidative stress,and the combined detection of 8-iso-PG and ET-1 can be used as a good index foRevaluating the severity and treatment of patients with AECOPD and PAH.

Objective To explore the value of 8-iso-PG and endothelin (ET-1) detections in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary hypertension (PAH).Methods A total of 40 AECOPD patients with pulmonary hypertension were randomly divided into treatment group and control group,anotheR20 COPD patients without pulmonary hypertension were selected as control group.According to the level of pulmonary arterial pressure,the patients were divided into subgroups,and correlation and changes of indexes were compared among groups.Results There were significant differences between the AECOPD group and combined PAH group in serum 8-iso-PG and endothelin levels (P<0.01).Correlation analysis showed that the levels of 8-iso-PG and ET-1 in the combined PAH group were not correlated with FVC,p(CO2) and FEV1 (P>0.05),but there was a negative lineaRcorrelation with p(O2) and was positively correlated with pulmonary artery pressure (P<0.05).There were significant differences in 8-iso-PG and ET-1 levels among different PAH groups (P<0.01).AfteRtreatment,levels of ET-1 and 8-iso-PG significantly reduced,FEV1 and FVC significantly increased (P<0.05),and the level of PASP reduced significantly in treatment group and control group (P<0.05).Conclusion 8-iso-PG can be used as a good markeRof oxidative stress,and the combined detection of 8-iso-PG and ET-1 can be used as a good index foRevaluating the severity and treatment of patients with AECOPD and PAH.

Objective:In order to develop an oral live vaccine vector of swine that can stably carry exogenous genes.Methods:Mutant ΔcrpΔcyaΔasdC78-1 was constructed by the method of suicide plasmid pREasd-mediated bacteria homologous recombination on the basis of attenuated Salmonella choleraesuisΔcrpΔcyaC78-1.Complementary plasmid pYA3493 with asd was electrotransformed into the mutant,and thenΔcrpΔcyaΔasdC78-1(pYA3493) host-vector balanced lethal system was constructed.Its biological characteristics were analyzed further.Results:The results of PCR and sequencing showed thatΔcrpΔcyaΔasdC78-1(pYA3493) was constructed suc-cessfully.Biological characteristics showed that the serotype of ΔcrpΔcyaΔasdC78-1(pYA3493) was identical to ΔcyaΔasdC78-1 and vaccine strain C500 and it can stably carry theΔasd gene in vitro;its growth speed was a little slower than ΔcrpΔcyaC78-1 strain,but both of their growth speeds were significantly slower than vaccine strain C500;the biochemical characteristics of ΔcrpΔcyaΔasdC78-1 ( pYA3493 ) were basically the same with ΔcrpΔcyaC78-1 strain.Oral virulence test in mice showed that the virulence ofΔcrpΔcyaΔasdC78-1 ( pYA3493 ) was similar with ΔcrpΔcyaC78-1, but its median lethal dose is 412 times of vaccine strain C500.Conclusion:These results demonstrated that attenuated Salmonella choleraesuisΔcrpΔcyaΔasdC78-1(pYA3493) strain had the potential to be used as an oral live vaccine vector for expressing foreign genes efficiently.

Objective To determine the median effective concentration (EC50) of amitriptyline for intravenous regional anesthesia (IVRA) in rats.Methods Ninety healthy male SD rata weighing 190-240 g were randomly divided into 3 groups (n=30 each) : amitripryline group,bupivncaine group and lidocaine group.The rat's tail was divided into 3 epual parts: the proximal,middle and distal part.A 24 gauge needle was inserted into vena caudalis in the distal part.Esmarch bandage was applied around the tail from distal to proximal to expel blood from the taft and was removed after a tourniquet was applied between the proximal and middle part of the tail to occlude artery.0.5 ml of amitriptyline,bupivncaine or lidocaine was injected into the taft vein immediately after the application of the tourniquet.Ten minutes after drug administration the tourniquet was released.The ECho was determined by the up-and-down sequence method.The initial concentration of amitriptyline was 0.05%,the consecutive concentration-ratio was 1.4i4; the initial concentration of bupivacaine was 0.03%,the consecutive concoatration-ratio was 1.667 and the initial concentration of lidncaine was 0.08%,the consecutive concentrationratio was 1.250.EC50 and 95% confidence interval were calculated.Tail-flick latency (TFL) was assessed at 1 h before (baseline) and at 3 min and 2 d after drug administration.Central nervous system toxicity (seizure,convulsion,death) and local tissue damage to the tail were also recorded.Results The EC50 for IVRA was 0.111% (95% CI,0.092%-0.133%) in amitripthline group; 0.058% (95% CI,0.048%-0.078%) in bupivacaine group and 0.129% (95% CI,0.103%-0.160%) in lidocaine group respectively.The EC50 was significantly lower in bupivacaine group than in amitriptyline and lidocaine group.There was no significant difference in EC50 between amitriptyline and lidocaine group.The TFL measured at the proximal part of the tail was not significantly different between different time points in each group.The TFL measured at the middle part at 3 rain after drug adminisuation was significantly increased as compared with the baseline in all 3 groups but was not significantly different between the baseline and that measured at 2 d after drug administration.No CNS toxicity and local tissue damage were found during the experiment in all 3 groups.Conclusion Amitriptyline can produce intravenous regional anesthesia.The potency of amitriptyline is significantly lower than that of bupivncaine but is not significantly different from that of lidocaine.