ObjectiveTo investigate the mechanism by which Wendantang regulates the silent information regulator 3 （SIRT3）/peroxisome proliferator-activated receptor-gamma coactivator-1α （PGC-1α） pathway to influence energy metabolism and thereby prevent and treat myocardial ischemia （MI） in a rat model of hyperlipidemia （HL）. MethodsThirty SD rats were randomly assigned into five groups： control， model， low-dose （3.702 g·kg^-1·d^-1） Wendantang， high-dose （7.404 g·kg^-1·d^-1） Wendantang， and positive control （trimetazidine， 0.006 g·kg^-1·d^-1）， with six rats in each group. The control group was fed normally， while the other groups were fed with a high-fat diet for six weeks for the modeling of HL. Subsequently， the drug intervention groups were administrated with corresponding drugs by gavage， and the control and model groups received an equivalent volume of normal saline for 14 days. One hour after the last gavage， the other groups except the control group were injected intraperitoneally with posterior pituitary hormone （30 U·kg^-1） to induce MI. Electrocardiography （ECG） was employed to detect changes in the electrocardiogram. Hematoxylin-eosin staining was performed to observe cardiac pathological changes. Enzyme-linked immunosorbent assay was employed to measure the serum levels of cardiac troponin I（cTnI）， myoglobin （MYO）， and creatine kinase-MB （CK-MB）. Colorimetry was used to determine the levels of total cholesterol （TC） and triglycerides （TG） in the serum and ATP， malondialdehyde （MDA）， and superoxide dismutase （SOD） in the myocardial tissue. Western blot was employed to determine the protein levels of SIRT3， PGC-1α， adenosine monophosphate-activated protein kinase （AMPK）， and phosphorylated AMPK （p-AMPK） in the myocardial tissue. Real-time PCR was employed to measure the mRNA levels of SIRT3， PGC-1α， and AMPKα in the myocardial tissue. ResultsCompared with the control group， the model group showed significant J-point deviation and elevation in the ECG image， increased heart rate， disarrangement of myocardial fibers with unclear boundaries， elevated levels of CK-MB， cTnI， MYO， TC， and TG （P<0.05， P<0.01）， declined levels of SOD and ATP （P<0.01）， down-regulated mRNA levels of SIRT3， PGC-1α， and AMPK （P<0.05）， and down-regulated protein levels of SIRT3， PGC-1α， and p-AMPK （P<0.05）. Compared with the model group， the low-dose and high-dose Wendantang groups and the trimetazidine group showed inhibited J-point deviation and elevation in the ECG image， slowed heart rate， reduced inflammatory cell infiltration， alleviated disarrangement of myocardial fibers， declined levels of CK-MB， cTnI， MYO， TC， and TG （P<0.05， P<0.01）， elevated level of SOD （P<0.01）， up-regulated mRNA levels of SIRT3， PGC-1α， and AMPK （P<0.05， P<0.01） and up-regulated protein levels of SIRT3， PGC-1α， and p-AMPK （P<0.05， P<0.01）. ConclusionWendantang can effectively intervene in HL-associated MI in rats by reducing oxidative stress in myocardial cells， alleviating lipid metabolism disorders， and improving myocardial energy metabolism via the SIRT3/PGC-1α signaling pathway.

Objective To evaluate the surgical efficacy of unilateral pneumonectomy for the treatment of tuberculous destroyed lung, analyze the causes of severe postoperative complications, and explore clinical management strategies. Methods A retrospective analysis was conducted on the clinical data of patients with tuberculous destroyed lung who underwent unilateral pneumonectomy at the Public Health Clinical Center of Chengdu from 2017 to 2023. Postoperative severe complications were statistically analyzed. Patients were divided into a non-severe complication group and a severe-complication group, and the causes, management, and outcomes of complications were analyzed. Results A total of 134 patients were included, comprising 69 males and 65 females, with a mean age of 17-73 (40.43±12.69) years. There were 93 patients undergoing left pneumonectomy and 41 patients undergoing right pneumonectomy. Preoperative sputum smear was positive in 35 patients, all of which converted to negative postoperatively. There were 58 patients with hemoptysis preoperatively, and none experienced hemoptysis postoperatively. Postoperative incisional infection occurred in 8 (5.97%) patients, and postoperative pulmonary infection in 26 (19.40%) patients. Severe postoperative complications occurred in 17 (12.69%) patients, including empyema in 9 (6.72%) patients, bronchopleural fistula with empyema in 1 (0.75%) patient, severe pneumonia in 3 (2.24%) patients, postpneumonectomy syndrome in 1 (0.75%) patient, chylothorax in 1 (0.75%) patient, ketoacidosis in 1 (0.75%) patient, and heart failure with severe pneumonia in 1 (0.75%) patient. Perioperative mortality occurred in 2 (1.49%) patients, both of whom underwent right pneumonectomy. Multivariate logistic regression analysis revealed that a history of ipsilateral thoracic surgery, concomitant Aspergillus infection, and greater blood loss were independent risk factors for severe complications following unilateral pneumonectomy for tuberculous destroyed lung (P<0.05). Conclusion Unilateral pneumonectomy for patients with tuberculous destroyed lung can significantly improve the clinical cure rate, sputum conversion rate, and hemoptysis cessation rate. However, there is a certain risk of severe perioperative complications and mortality, requiring thorough perioperative management and appropriate management of postoperative complications.

It uses research methods such as questionnaire surveys and in-depth interviews with key informants to investigate the quantitative data,settlement costs,satisfaction,and other actual operations of the"dual channel"electronic prescription circulation and medical insurance online settlement pilot project in Shenzhen in June 2022.It explores and analyzes its advantages in effectively eliminating counterfeit paper prescriptions,real-time sharing of pharmacy inventory,transparency of drug prices,and limitations in prescription circulation coverage.And it makes suggestions for optimizing the prescription review process,such as creating a unified and standardized prescription circu-lation model,constructing a standardized and efficient management system for purchased drug catalogs,and strengthening information privacy and data security,are proposed.

It uses research methods such as questionnaire surveys and in-depth interviews with key informants to investigate the quantitative data,settlement costs,satisfaction,and other actual operations of the"dual channel"electronic prescription circulation and medical insurance online settlement pilot project in Shenzhen in June 2022.It explores and analyzes its advantages in effectively eliminating counterfeit paper prescriptions,real-time sharing of pharmacy inventory,transparency of drug prices,and limitations in prescription circulation coverage.And it makes suggestions for optimizing the prescription review process,such as creating a unified and standardized prescription circu-lation model,constructing a standardized and efficient management system for purchased drug catalogs,and strengthening information privacy and data security,are proposed.

It uses research methods such as questionnaire surveys and in-depth interviews with key informants to investigate the quantitative data,settlement costs,satisfaction,and other actual operations of the"dual channel"electronic prescription circulation and medical insurance online settlement pilot project in Shenzhen in June 2022.It explores and analyzes its advantages in effectively eliminating counterfeit paper prescriptions,real-time sharing of pharmacy inventory,transparency of drug prices,and limitations in prescription circulation coverage.And it makes suggestions for optimizing the prescription review process,such as creating a unified and standardized prescription circu-lation model,constructing a standardized and efficient management system for purchased drug catalogs,and strengthening information privacy and data security,are proposed.

It uses research methods such as questionnaire surveys and in-depth interviews with key informants to investigate the quantitative data,settlement costs,satisfaction,and other actual operations of the"dual channel"electronic prescription circulation and medical insurance online settlement pilot project in Shenzhen in June 2022.It explores and analyzes its advantages in effectively eliminating counterfeit paper prescriptions,real-time sharing of pharmacy inventory,transparency of drug prices,and limitations in prescription circulation coverage.And it makes suggestions for optimizing the prescription review process,such as creating a unified and standardized prescription circu-lation model,constructing a standardized and efficient management system for purchased drug catalogs,and strengthening information privacy and data security,are proposed.

It uses research methods such as questionnaire surveys and in-depth interviews with key informants to investigate the quantitative data,settlement costs,satisfaction,and other actual operations of the"dual channel"electronic prescription circulation and medical insurance online settlement pilot project in Shenzhen in June 2022.It explores and analyzes its advantages in effectively eliminating counterfeit paper prescriptions,real-time sharing of pharmacy inventory,transparency of drug prices,and limitations in prescription circulation coverage.And it makes suggestions for optimizing the prescription review process,such as creating a unified and standardized prescription circu-lation model,constructing a standardized and efficient management system for purchased drug catalogs,and strengthening information privacy and data security,are proposed.

It uses research methods such as questionnaire surveys and in-depth interviews with key informants to investigate the quantitative data,settlement costs,satisfaction,and other actual operations of the"dual channel"electronic prescription circulation and medical insurance online settlement pilot project in Shenzhen in June 2022.It explores and analyzes its advantages in effectively eliminating counterfeit paper prescriptions,real-time sharing of pharmacy inventory,transparency of drug prices,and limitations in prescription circulation coverage.And it makes suggestions for optimizing the prescription review process,such as creating a unified and standardized prescription circu-lation model,constructing a standardized and efficient management system for purchased drug catalogs,and strengthening information privacy and data security,are proposed.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To preliminarily evaluate the effects and analyze the influencing factors of continuous renal replacement therapy (CRRT) in severe burn patients complicated with acute kidney injury (AKI).Methods:This study was a retrospective case series study. From January 2010 to December 2020, 79 severe burn patients complicated with AKI who received CRRT and met the inclusion criteria were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University). The general data (the same below) of all patients were collected, including gender, age, body mass index, burn area, burn index, cause of injury, whether combined with inhalation injury, acute physiology and chronic health status evaluation Ⅱ (APACHE Ⅱ) score and sepsis-related organ failure assessment (SOFA) score on admission, admission time after burn, and time of AKI after admission. The total efficacy of CRRT, including overall effective rate, complete effective rate, partial effective rate, ineffective rate, and deterioration rate, creatinine, urea, cystatin C, and fluid overload rate before and after treatment, in-hospital mortality, predictive mortality based on Baux scoring model, the most common cause of death, and length of hospital stay were recorded. According to the effect of CRRT, the patients were divided into effective group (42 patients) and ineffective group (37 patients). The general information of patients, the time to initiate CRRT after the occurrence of AKI, the duration of CRRT, etiology of AKI, AKI stage before CRRT initiation, CRRT mode, anticoagulant type, and in-hospital mortality were compared between the two groups of patients. The independent influencing factors for CRRT in severe burn patients complicated with AKI were screened. According to the etiology of AKI, the patients were divided into prerenal group (22 patients) and renal group (57 patients). The general information of patients, the time to initiate CRRT after the occurrence of AKI, the duration of CRRT, and total efficacy of CRRT (except for the most common cause of death) were compared between the two groups of patients.Results:Among the 79 patients, 73 cases were male and 6 cases were female, with age of (46±14) years, body mass index of (24.0±2.9) kg/m 2, total burn area of (69±26)% total body surface area (TBSA), full-thickness burn area of (44±25)%TBSA, and burn index of 57 (36, 76). There were 36 cases of flame burns, 19 cases of electrical burns, 16 cases of hydrothermal burns, 6 cases of explosive burns, and 2 cases of chemical burns. Thirty-nine patients were complicated with inhalation injury. The APACHE Ⅱ score was 16 (12, 18) and the SOFA score was 11 (5, 13) on admission. The patients were admitted to the hospital on 0 (0, 2) d after burn, and AKI occurred on 0 (0, 6) d after admission. The overall effective rate of CRRT was 53.16% (42/79), the complete effective rate was 30.38% (24/79), the partial effective rate was 22.78% (18/79), the ineffective rate was 31.65% (25/79), and the deterioration rate was 15.19% (12/79). The creatinine and urea of patients after treatment were significantly lower than those before treatment (with Z values of -3.26 and -2.54, respectively, P<0.05); there were no statistically significant differences in the cystatin C and fluid overload rate of patients before and after treatment ( P>0.05). The in-hospital mortality of patients was 17.72% (14/79), and the predictive mortality based on Baux scoring model was 75.10% (18.94%, 91.84%). The most common cause of death was multiple organ failure, and the length of hospital stay was 39.43 (11.52, 110.58) d. There were statistically significant differences in the full-thickness burn area, the duration of CRRT, and etiology of AKI of patients between effective group and ineffective group (with Z values of -1.99 and -2.90, respectively, χ2=5.58, P<0.05). There were no statistically significant differences in the other indicators ( P>0.05). The etiology of AKI and full-thickness burn area were the independent influencing factors for CRRT in severe burn patients complicated with AKI (with odds ratios of 4.21 and 1.03, respectively, 95% confidence intervals of 1.20-14.80 and 1.00-1.05, respectively, P<0.05). There were statistically significant differences in the cause of injury, overall effective rate of CRRT, total burn area, burn index, admission time after burn, time of AKI after admission, the time to initiate CRRT after the occurrence of AKI, and predictive mortality based on Baux score model of patients between prerenal group and renal group (with χ2 values of 12.59 and 5.58, respectively, Z values of 2.46, 2.43, -2.43, -4.03, -3.01, and -2.31, respectively, P<0.05). Before treatment, urea and cystatin C of patients in renal group were significantly higher than those in prerenal group (with Z values of -2.98 and -2.77, respectively, P<0.05), and the liquid overload rate was significantly lower than that in prerenal group ( Z=-2.99, P<0.05); after treatment, the cystatin C of patients in renal group was significantly higher than that in prerenal group ( Z=-2.08, P<0.05); there were no statistically significant differences in the other indicators ( P>0.05). Conclusions:CRRT can significantly improve renal function, avoid fluid overload, and alleviate renal injury in severe burn patients complicated with AKI. Prerenal AKI is the main independent influencing factor leading to ineffective CRRT.