Bronchial asthma （asthma for short） is a common clinical respiratory disease mainly characterized by chronic airway inflammation， with complicated pathogenesis and a long treatment cycle. It is lingering and difficult to be cured， and lack specific drugs. Oxidative stress is a new focus in the research on the pathogenesis of asthma and a potential key target for the treatment. Under physiological conditions， the oxidative and antioxidative systems in the body are in a dynamic balance， and the two antagonize each other to maintain normal life activities. In the case of asthma attack， oxidation products such as reactive oxygen species （ROS）， malondialdehyde （MDA）， and nitric oxide （NO） are produced excessively， while the content of antioxidants such as superoxide dismutase （SOD）， catalase （CAT）， and glutathione （GSH） is reduced. As a result， the oxidation exceeds the removal of oxidation products， which aggravates oxidative stress. In addition， the overproduction of ROS activates oxidative stress-related signaling pathways to produce pro-inflammatory factors， exacerbating inflammation， which leads to lung and airway tissue damage. In recent years， traditional Chinese medicine has garnering increasing attention because of the unique advantages in the treatment of asthma， especially in regulating redox balance， alleviating oxidative stress in asthma patients， and reducing inflammation. On the one hand， by inhibiting the mitogen-activated protein kinase （MAPK） and transcription factor （NF）-κB signaling pathways， traditional Chinese medicine can reduce the content of oxidation products and pro-inflammatory factors from the source. On the other hand， by activating the nuclear factor-erythroid 2-related factor 2 （NrF2） signaling pathway， traditional Chinese medicine can elevate the levels of antioxidant enzymes and enhance the antioxidant system to neutralize the excessive accumulation of oxidation products. Therefore， the adjustment of redox balance state by traditional Chinese medicine may be a new means and a new direction for the prevention and treatment of asthma in the future. This paper summarizes the oxidative stress-related pathways in the pathogenesis of asthma and reviews the latest research progress in the regulation of oxidative stress-related pathways by Chinese medicine extracts and prescriptions in the treatment of asthma， with a view to providing a fuller， more solid， and more scientific theoretical basis for the clinical and basic research on the prevention and treatment of asthma by traditional Chinese medicine.

Objective:To gain a deeper understanding of the comorbidity status of elderly patients with coronary heart disease and the effect of comorbidity on their hospitalization costs.Methods:Using the convenient sampling method, a total of 8 334 elderly hospitalized patients diagnosed with coronary heart disease in Beijing Hospital from January 2018 to December 2021 were selected as the research objects. General Inforamtion Questionnaire and Charson comorbidity index (CCI) were used to investigate the comorbidity of patients.Results:Among the 8 334 elderly patients with coronary heart disease included, 88.18% (7 349/8 334) had comorbidity, and there was a statistically significant difference in hospital costs among patients with different CCI scores ( P<0.01). Elderly patients with coronary heart disease with comorbidity had higher hospital costs. The results of the binomial logistic regression analysis showed that comorbidities increased the hospitalization costs of elderly coronary heart disease patients in both the unadjusted model and the gradually adjusted model for age, gender, occupation, education level, admission department, admission status, admission year, admission mode length of stay and disease classification ( P<0.05) . Conclusions:The comorbidity in elderly patients with coronary heart disease is serious, which is an important factor affecting hospitalization costs. In medical practice, it is necessary to strengthen the comprehensive management of elderly patients with coronary heart disease, pay attention to the influencing factors of hospitalization costs, optimize prevention and treatment strategies, control the occurrence and progression of comorbidities among patients, deepen the reform of medical insurance payment methods such as grouping payments based on disease diagnosis, so as to accurately reduce hospitalization costs and promote the sustainable and healthy development of the medical and health system.

Promoting the transformation and development of public hospitals into clinical research-oriented hospitals is the necessary way for China to deepen the reform of medicine and health system. In August 2019, Henan Cancer Hospital deeply combined the key elements of clinical research management with the concept of multidisciplinary collaborative governance, created an offline operating end of collaborative governance (including the front collaborative recruitment system, the middle collaborative quality management system, and the terminal collaborative transformation system), built a supporting internet plus intelligent auxiliary end (including the intelligent recruitment manager, the intelligent quality manager and the intelligent transformation manager), and built a clinical research intelligent management mode covering the trinity of subject recruitment, clinical research quality control, and innovation achievements transformation. The hospital focused on management elements such as " focusing on quality, improving efficiency, and increasing motivation" , and drove the front, middle, and terminal ends of the model to work together, to ensure the quality and efficiency of clinical research and achieve a comprehensive improvement in the hospital′s clinical research level. As of December 2023, the hospital had undertaken over 2 000 clinical research projects of various types, with a cumulative amount of clinical research conversion contracts exceeding 53 million yuan. This practice had achieved good results and could provided references for other tertiary public hospitals to promote high-quality development of clinical research.

Objective To analyze the clinical characteristics and risk factors of small airway dysfunction(SAD)in patients with asthma.Methods The clinical data of 200 patients with chronic persistent asthma were included,including general data,disease-related condition,pulmonary function test result,compliance assessment and asthma control status.The clinical features of the two groups were compared.Logistic regression was used to analyze risk factors for asthma SAD,and ROC curves were plotted to assess the predictive power of the model.Results Two hundred patients were divided into the SAD group(128 cases)and the non-SAD group(72 cases).The main risk factors of SAD in patients with chronic persistent asthma included smoking history(OR=4.758,95%CI:2.043-11.081),overweight(OR=2.952,95%CI:1.428-6.105),asthma without clinical remission(OR=6.140,95%CI:2.929-12.870),acute asthma attack in recent 1 year(OR= 3.406,95%CI:1.430-8.117)and allergic rhinitis(OR=2.289,95%CI:1.121-4.673).The area under the curve(AUC)of above risk factors were 0.612,0.610,0.716,0.614 and 0.600,respectively.The AUC of the composite prediction model was 0.826(95%CI:0.769-0.883),which had good prediction value.Conclusion Smoking,overweight,acute asthma attack in recent one year,non-remission period of asthma and allergic rhinitis are independent risk factors for SAD in chronic persistent asthma.The risk factors of SAD should be identified as early as possible,and individualized monitoring and treatment should be taken.

Objective:To systematically analyze the clinical features of severe fever with thrombocytopenia syndrome (SFTS) and to provide evidence for the prevention and treatment of SFTS.Methods:Relevant studies of SFTS from six databases, including China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP, PubMed, Cochrane Library and Embase from January 2009 to May 2019 were systematically searched and identified. The literatures were screened and the data of patients′ epidemiology, clinical manifestations, laboratory examinations and prognosis were obtained. Revman 5.2 software was used for meta analysis.Results:Sixty-eight Chinese literatures and fourteen English literatures encompassing 6 780 patients with SFTS were included in the final analysis. Of these patients, 845 cases (12.46%) died. SFTS mostly occurred in mountainous and hilly areas, and farmers (3 637 cases) were the usual victims. The onset season was mostly in summer and the peak was from May to August each year. There were 1 434 patients had a clear history of tick bites, and 21 cases were human-to-human transmitted.There were 6 071 cases (89.54%) presented with fever, 5 407 cases (79.75%) presented with fatigue, 3 140 cases (46.31%) presented with muscle soreness, and 2 300 cases (33.92%) presented with chills.Using random effects model for meta analysis, the levels of creatine kinase (CK) (mean difference ( MD)=500.40, 95% confidence interval ( CI) 380.51-620.28, P<0.01) and lactic acid dehydrogenase (LDH)( MD=442.81, 95% CI 152.85-732.78, P=0.003) in severe patients were both higher than those in mild patients, and the difference were both statistically significant. The risk of death increased in patients aged>60 years( MD=8.19, 95% CI 4.03-12.36, P<0.01). The levels of CK( MD=530.92, 95% CI 29.27-1 032.56, P=0.040), LDH( MD=609.28, 95% CI 80.25-1 138.31, P=0.020), urea nitrogen ( MD=4.67, 95% CI 3.05-6.30, P<0.01) and creatinine ( MD=43.05, 95% CI 23.49-62.62, P<0.01) of patients in the death group were all higher than those in the survival group. The differences were all statistically significant. Conclusions:During the course of SFTS, the patients may show impaired blood system, heart, liver and kidney functions with high mortality. Clinicians should timely monitor the changes of blood routine, myocardial enzyme spectrum, liver and kidney functions and other indicators, so as to find cardiovascular and other system complications as early as possible. Timely treatment could not only reduce liver, heart and other organ injuries, but also reduce mortality.

Objective: To investigate the clinical characteristics and outcomes of Maisonneuve fractures. Methods: Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days). Results: Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21). Conclusion The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.

Objective: To compare the scores of periocular wrinkle and blepharochalasis of the patients before and after the treatment of ultra-pulsed fractional CO2laser with low energy,and to illuminate the efficacy of ultra-pulsed fractional CO2laser with lower energy in eyelid rejuvenation including periocular wrinkle and blepharochalasis.Methods:Thirty patients with periocular wrinkles and blepharochalasis who met the inclusion criteria were selected. The patients were treated with ultra-pulsed fractional CO2laser; the laser parameters were 10 mm spot size, pulse energy 5 mJ and repetition rate 600 Hz and the wrinkle walking areas were treated with 2 mm spot size and the same energy again. Two senior dermatologists scored according to the eyelid laxity scale before treatment and 7 d, 1 month, 3 months and 6 months after treatment, and statistical analysis was performed.Results: Compared with before treatment,there was no significant difference in the scores of eyelid laxity scale 7 d after treatment(P>0.05); the score of eyelid laxity scale was significantly decreased 1 month after treatment (P<0.05);the scores of eyelid laxity scale were significantly decreased 3-6 months after treatment (P<0.01),and the curative effect was more obvious.In this group of 30 patients, there were usually transient erythema, swelling and mild burning pain after treatment. But no serious complications occurred. Conclusion: Ultra-pulsed fractional CO2laser with lower energy(5 mJ) can improve the periocular wrinkles and blepharochalasis effectively with high security and without severe side effects.

Objective: To evaluate the effect of computer-assisted design based on three-dimensional reconstruction technique on the reduction accuracy of tibial and fibular fractures with Taylor external fixation. Methods: A retrospective review was conducted on the clinical data of 69 patients who had tibia and fibula fractures treated with Taylor external fixation in department of orthopedic trauma of Tianjin Hospital from January 2016 to January 2018 to compare the residual deformity after fracture reduction between computer-assisted design method (experimental group) and the standard measurement method (control group). The frontal and lateral tibia and fibula X-ray of all the affected limbs were taken. In experimental group, all the patients took bilateral tibial CT tomography, and then DICOM format documents were input into the Mimics 17.1 software and got three-dimensional models of targeted bone and external fixation ring. After that the visual image matching was performed between external fixation ring three-dimensional reconstruction model and the standard model and also between the affected limb and the contralateral limb. Then the reduction trajectory plan of bone broken end and the position of external fixation ring were obtained. The STL files were input to Solid Works software and got the length of six rods to adjust the Taylor external fixation. In control group, the films were measured by Coreldraw X7 X-ray measurement software and the parameters were input in Taylor Spatial Frame system software. And then six calibrated threaded rods were adjusted according to the prescription of the software. Finally, all the patients took the X-ray films again to evaluate the degree of residual displacement. Skew distributional data are indicated with M(Q_R), and method of non-parameter was used to analyze variances between groups. Results: All patients had better fracture reduction and achieved functional reset criteria. In the control group, the amount of displacement and angle residual aberration (improvement) in the frontal and lateral radiographs were 0.50(2.30)mm(90%), 0.00(0.85)mm(100%)and 0.00°(1.50°)(100%), 0.00°(0.00°)(100%), respectively. In the control group, the amount of displacement and angle residual aberration (improvement) in the frontal and lateral radiographs were 1.40(3.28)mm(69%), 2.15(4.27)mm(46%)and 1.15°(1.85°)(73%), 0.80°(2.10°)(67%). The positive and lateral angles and lateral displacements in the two groups were significantly different(P<0.05), but there was no statistically significant difference in positive displacement (P=0.099). Conclusion Both computer-assisted design method and the standard measurement method have satisfactory reduction effect, but computer-assisted design can accurately correct fracture deformity, which is good for fracture healing and functional recovery of affected limb.

Objective: To investigate the role of enolase 1 (ENO1) in hepatocellular carcinoma (HCC) and possible mechanism. Methods: Real-time PCR and Western blot were used to measure the expression of ENO1 in HCC tissue, adjacent tissue, hepatoma cells, and normal hepatocytes. The siRNA interference technique was used for ENO1 knockout in HepG2 cells, and then CCK-8, colony formation assay, and transwell assay were used to measure the proliferation, migration, and invasion abilities of HepG2 cells. Real-time PCR and Western blot were used to measure the expression of proteins and genes involved in the activation of the Notch signaling pathway. The two-independent-samples t test and a one-way analysis of variance were used for comparison. Results: HCC tissue and HepG2 cells had significantly higher expression of ENO1 than adjacent tissue and normal hepatocytes (P < 0.05). There were significant reductions in the proliferation, migration, and invasion abilities of HepG2 cells after siRNA interference (P < 0.05). There were also significant reductions in the expression of N1ICD, snail, slug, HEY1, HES1, and HES5 (P < 0.05). Conclusion ENO1 may promote the development of HCC, possibly by participating in the regulation of the Notch signaling pathway.

Objective To explore radiographic and MRI features of the hemangiomas and vascular malformation in the deep soft-tissue of the extremities.Methods 89 cases confirmed by surgical pathology and angiography were analyzed retrospectively with clinical data and radiological findings.Imaging exams included plain X-ray performed in all patients,and MRI scan in 33 patients.Results On X-ray plain film,there was normal bone and soft tissue in 54 cases(60.7%),soft tissue abnormalities in 14 cases(1 5.7%),and phleboliths in 30 cases(33.7%).Also,plain X-ray film studies demonstrated bone changes adjacent to the deep soft tissue in 32 cases(36.0%), including periosteal reactions(13 cases),cortical erosion (1 6 cases),involvement of the bone marrow (10 cases)and 7 diffuse lesions with all above changes.On MRI,lesions were similar to honeycomb or sponge,and T1 WI showed isohypointense signal in 25 cases (75.8%),hypointense in 5 cases (1 5.2%),inhomogeneous slightly hyperintense in 3 cases (9.0%).On T2 WI,all lesions were well defined and showed hyperintense signals with hypointense septation,of which there were 9 cases with nodular hypointense areas and vascular flow effect.Hypointense phleboliths were showed in 10 cases(30.3%).Following injection of the contrast medium,all lesions had heterogeneous enhancement patterns.Of the 33 patients studies with MRI,lesions of 18 cases(54.5%)had bone changes which were adjacent to or partially or fully wrapped by neighbouring soft tissue lesions,in which lesions of 12 cases showed abnormal signal within bone marrow and lesions of 3 cases with vascular flow void phenomenon.In 15 cases (45.5%)without osseous change,lesions of 3 cases were adjacent to bone,and lesions of 12 cases were with fat and muscle septum between the bone and lesions.Conclusion The hemangiomas and vascular malformation in the deep soft-tissue of the extremities may cause changes in adjacent bones.Familiarity with the performance of reactive bone changes on X-ray and MRI may help to improve the diagnosis and avoid misdiagnosis.