Objectives:This study aims to investigate the association between intraoperative hypotension(IOH)and postoperative stroke within 7 days following off-pump coronary artery bypass grafting(OPCABG).Methods:A retrospective analysis was conducted on 1 006 patients who underwent elective OPCABG at our hospital between April 2023 and April 2024.According to whether the mean arterial pressure(MAP)decreased to 55 mmHg during the operation and the corresponding time,the patients were divided into three groups:non-hypotension group(n=632),short-term hypotension group(MAP<55 mmHg cumulative time<15 minutes,n=279)and long-term hypotension group(MAP<55 mmHg cumulative time≥15 minutes,n=95).To study the effect of the cumulative duration of hypotension on cerebral perfusion when MAP<55 mmHg was used as the critical value of hypotension.The primary outcome measure was early ischemic stroke within 7 days after surgery.Results:The incidence of early postoperative ischemic stroke was 0.6%,3.6%and 1.1%in the non-hypotension group,short-term hypotension group and long-term hypotension group,respectively.Compared with the non-hypotension group,the incidence of early postoperative ischemic stroke in the short-term hypotension group was significantly higher(P<0.0167).Multivariate logistic regression analysis showed that compared with the non-hypotension group,short-term IOH(OR=6.535,95%CI:1.980-21.574,P=0.002)and preoperative serum creatinine level(OR=1.023,95%CI:1.008-1.039,P=0.002)were associated with the occurrence of ischemic stroke within 7 days after operation,long-term IOH was not associated with ischemic stroke within 7 days after operation(OR=1.691,95%CI:0.178-16.029,P=0.647).Conclusions:The occurrence of ischemic stroke after off-pump coronary artery bypass grafting is related to short-term IOH,but not to long-term IOH.

Objective To investigate the effects of Aurora kinase A(AURKA)on the tumor microenvironment of colorectal cancer(CRC)and to predict the active compounds in Chinese herbs that can target AURKA.Methods Based on the transcriptomic data and clinical information from 380 CRC tissues and 51 paracancerous tissues in The Cancer Genome Atlas(TCGA)database,the infiltration of different cells in the tumor tissues was analyzed using xCell and the binding of active compounds of Chinese herbs with AURKA was predicted through molecular docking.Results The expression of AURKA was significantly upregulated in CRC tissues compared with that in paracancerous tissues(P＜0.05),and CRC patients with high AURKA expression had shorter overall survival.Compared with the AURKA low-expression group,the abundance of macrophages,monocytes,and effector memory CD4+and CD8+T cells was significantly downregulated in the AURKA high-expression group(P＜0.05).In addition,the cytotoxicity of T cells was significantly reduced(P＜0.05).Further analysis revealed that AURKA expression was positively correlated with the abundance of myeloid-derived suppressor cells(MDSCs)and the expression levels of their chemokines CXCL2 and CXCL5(P＜0.05).Genes that were differentially expressed between the AURKA high-and low-expression groups were mainly enriched in monocyte migration,chemokine-induced cellular responses,and other related processes.Chinese herbal compounds,including hesperidin,aristololactam A Ⅱ a,anacardic acid,coumestrol,and 17β-estradiol,all showed binding energies to AURKA lower than-1.2 kcal/mol,indicating a certain level of binding stability.Among these Chinese herbal compounds,17β-estradiol exhibited the best binding stability to AURKA-3UOL.Conclusion The high expression of AURKA in CRC tissues suggests a poor clinical prognosis.AURKA can promote the development of a suppressive immune microenvironment in CRC,and 17β-estradiol,an active compound from Chinese herbs,is a potential therapeutic agent targeting AURKA.

Objective To explore the effect of lipoprotein a[Lp(a)]on the inflammatory state and cardiovascular system of patients with essential hypertension.Methods The clinical data of 234 patients with essential hypertension admitted from January 2022 to November 2023 were retrospectively collected.According to the serum Lp(a)concentration,they were divided into the normal Lp(a)group(n=185)and the high Lp(a)group(n=49).The differences in serum inflammatory markers C reactive protein(CRP),neutrophil-to-lymphocyte ratio(NLR),and fibrinogen between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between Lp(a)and inflammatory markers,and the incidence of cardiac target organ damage between the two groups of patients was compared.Results Compared with the normal Lp(a)group,the CRP concentration,NLR and fibrinogen concentration of hypertensive patients in the high Lp(a)group increased(P<0.05,P<0.01),and the concentration of Lp(a)was positively correlated with CRP,NLR and fibrinogen(r=0.168,0.165,0.321,P<0.05).The incidence of myocardial infarction was higher in the high Lp(a)group[22.45%(11/49)]than in the normal Lp(a)group[7.57%(14/185)](P<0.01).Conclusion In patients with essential hypertension,high Lp(a)concentration is associated with a stronger inflammatory response,and elevated Lp(a)concentration is related to an increased incidence of myocardial infarction,suggesting that Lp(a)may affect target organ damage in patients with essential hypertension by promoting inflammation.

Objective To explore the effect of lipoprotein a[Lp(a)]on the inflammatory state and cardiovascular system of patients with essential hypertension.Methods The clinical data of 234 patients with essential hypertension admitted from January 2022 to November 2023 were retrospectively collected.According to the serum Lp(a)concentration,they were divided into the normal Lp(a)group(n=185)and the high Lp(a)group(n=49).The differences in serum inflammatory markers C reactive protein(CRP),neutrophil-to-lymphocyte ratio(NLR),and fibrinogen between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between Lp(a)and inflammatory markers,and the incidence of cardiac target organ damage between the two groups of patients was compared.Results Compared with the normal Lp(a)group,the CRP concentration,NLR and fibrinogen concentration of hypertensive patients in the high Lp(a)group increased(P<0.05,P<0.01),and the concentration of Lp(a)was positively correlated with CRP,NLR and fibrinogen(r=0.168,0.165,0.321,P<0.05).The incidence of myocardial infarction was higher in the high Lp(a)group[22.45%(11/49)]than in the normal Lp(a)group[7.57%(14/185)](P<0.01).Conclusion In patients with essential hypertension,high Lp(a)concentration is associated with a stronger inflammatory response,and elevated Lp(a)concentration is related to an increased incidence of myocardial infarction,suggesting that Lp(a)may affect target organ damage in patients with essential hypertension by promoting inflammation.

Objectives:This study aims to investigate the association between intraoperative hypotension(IOH)and postoperative stroke within 7 days following off-pump coronary artery bypass grafting(OPCABG).Methods:A retrospective analysis was conducted on 1 006 patients who underwent elective OPCABG at our hospital between April 2023 and April 2024.According to whether the mean arterial pressure(MAP)decreased to 55 mmHg during the operation and the corresponding time,the patients were divided into three groups:non-hypotension group(n=632),short-term hypotension group(MAP<55 mmHg cumulative time<15 minutes,n=279)and long-term hypotension group(MAP<55 mmHg cumulative time≥15 minutes,n=95).To study the effect of the cumulative duration of hypotension on cerebral perfusion when MAP<55 mmHg was used as the critical value of hypotension.The primary outcome measure was early ischemic stroke within 7 days after surgery.Results:The incidence of early postoperative ischemic stroke was 0.6%,3.6%and 1.1%in the non-hypotension group,short-term hypotension group and long-term hypotension group,respectively.Compared with the non-hypotension group,the incidence of early postoperative ischemic stroke in the short-term hypotension group was significantly higher(P<0.0167).Multivariate logistic regression analysis showed that compared with the non-hypotension group,short-term IOH(OR=6.535,95%CI:1.980-21.574,P=0.002)and preoperative serum creatinine level(OR=1.023,95%CI:1.008-1.039,P=0.002)were associated with the occurrence of ischemic stroke within 7 days after operation,long-term IOH was not associated with ischemic stroke within 7 days after operation(OR=1.691,95%CI:0.178-16.029,P=0.647).Conclusions:The occurrence of ischemic stroke after off-pump coronary artery bypass grafting is related to short-term IOH,but not to long-term IOH.

ObjectiveTo validate the efficacy of Yunpi Huatan Tongqiao prescription （YHTP） in down-regulating glycolysis to modulate microglia phenotype and improve inflammation and cognitive memory deficits in obstructive sleep apnea （OSA） mice. MethodForty-eight male Balb/C mice were randomly divided into a normal group， a model group， a montelukast sodium group （30 mg·kg^-1）， and low， medium， and high dose groups of YHTP （8.28， 16.56， and 33.12 g·kg^-1）， with 8 mice in each group. All groups， except the normal group， received intraperitoneal injections of lipopolysaccharide （LPS） and underwent chronic intermittent hypoxia （CIH） modeling for 4 weeks. Subsequently， the mice were treated with medications for 4 weeks and then sampled. Animal behavioral tests assessed memory impairment due to hypoxia. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to measure mRNA expression levels of M1-associated inflammatory factors interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， and markers such as T lymphocyte activation antigen （CD86） and inducible nitric oxide synthase （iNOS）， as well as M2-associated inflammatory factors interleukin-10 （IL-10）， transforming growth factor-β （TGF-β）， and the marker mannose receptor （CD206） in hippocampal tissue. Western blot was employed to detect differences in the expression of M1 and M2 microglia phenotypic markers （CD86， CD206） and glycolysis-related proteins glucose transporter type 1 （GLUT1）， hexokinase 2 （HK2）， phosphofructokinase （PFKM）， pyruvate kinase 2 （PKM2）， and monocarboxylic acid transporter 1 （MCT1）. ResultBehavioral tests showed that compared to the results in the normal group， the Y-maze autonomous alternation rate was significantly reduced in the model group （P<0.01）. The latency time for the target hole in the Barnes' maze during the training period （days 2， 3， 4） and testing period （days 5， 12） was significantly increased （P<0.05， P<0.01）. M1 glial cell markers CD86 and iNOS， as well as inflammatory factors IL-1β and TNF-α mRNA， were significantly elevated （P<0.01）. In contrast， the mRNA expression of M2 glial cell markers IL-10， CD206， and TGF-β was significantly reduced （P<0.01）. The protein expression of glycolytic proteins HK2， PFKM， PKM2， MCT1， and the M1 marker CD86 was significantly increased （P<0.05， P<0.01）， while M2 marker CD206 protein expression was significantly decreased （P<0.01）. Compared to the results in the model group， the Y-maze autonomous alternation rate was significantly increased in the medium and high dose groups of YHTP （P<0.05， P<0.01）. The latency time for the target hole during the training （day 4） and testing periods （days 5， 12） was significantly reduced （P<0.01）. Real-time PCR results indicated that mRNA expression levels of M1-related pro-inflammatory factors in the hippocampal tissue were significantly reduced in the low， medium， and high dose groups of YHTP （P<0.01）， while M2-related inflammatory factors' mRNA expression was significantly increased （P<0.01）. Western blot results showed that in the medium and high dose groups of YHTP， the expression of the M1 marker CD86 in the hippocampus was reduced， whereas the expression of the M2 marker CD206 was significantly increased （P<0.01）， with a significant decrease in the expression of glycolysis-related proteins （P<0.01）. ConclusionYHTP can improve inflammation and cognitive impairment induced by hypoxia in OSA model mice. This is achieved by downregulating glycolysis in brain microglia， inhibiting M1 activation， reducing pro-inflammatory factor release， and promoting M2 activation， thereby exerting a therapeutic effect on inflammation and cognitive impairment caused by OSA.

Objective To explore the clinical effect of Buqi Huayu prescription on chronic atrophic gastritis with intestinal metaplasia.Methods A total of 60 patients with chronic atrophic gastritis and intestinal metaplasia in the Department of Spleen and Stomach Diseases,Jinhua Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from April 2019 to June 2020 were selected and randomly divided into Buqi Huayu prescription group and control group,with 30 cases in each group.Patients in Buqi Huayu prescription group were treated with Buqi Huayu prescription;Patients in control group were treated with folic acid tablets.After 6 months of treatment,the clinical comprehensive efficacy,traditional Chinese Medicine syndrome score,pathological change score,serum pepsinogen(PG)Ⅰ,PGⅡ,PGⅠ/PGⅡ(PGR)were observed before and after treatment in two groups.Results The clinical curative effect of Buqi Huayu prescription group was significantly better than that of control group(90%vs.70%,P<0.05).After treatment,traditional Chinese Medicine syndrome score and gastric mucosa pathology score of two groups were lower than before treatment(P<0.05).The intestinal metaplasia score of Buqi Huayu prescription group was significantly higher than that of control group(P<0.05).The levels of PGⅠ and PGR were higher than before treatment,while the levels of PGⅡ were lower than before treatment(P<0.05).All the indexes in Buqi Huayu prescription group were better than those in control group(P<0.05).Conclusion Buqi Huayu prescription is effective in the treatment of chronic atrophic gastritis with intestinal metaplasia.It can not only improve the pathological changes of patients,but also increase the level of serum PGⅠ and PGR,and decrease the level of PGⅡ.

Objective:To explore the risks of medication errors of insulin degludec (IDeg) in clinical application using failure mode and effect analysis (FMEA).Methods:A research group on the risk points of medication errors was established in the First Affiliated Hospital of Shandong First Medical University. The risk points of medication errors were collected through questionnaire survey, literature research, and on-the-spot investigation. The severity, frequency of occurrence, and likelihood of detection were scored to determine the risk priority number (RPN) and formulate corresponding preventive measures.Results:After comprehensive evaluation, 32 risk points were found in the 4 links of physician prescription, pharmacist dispensing, nurse administration, and patient medication. The RPN was ranked from high to low, and 10 key risk points (RPN>70 points) were selected. (1) The pharmacist did not give the patients guidance on the use of IDeg; (2) Patients did not know that they should actively report to the physicians about the use feeling and adverse reactions of the drug; (3) Patients did not clear about the content of medication monitoring; (4) Patients did not master how to use the drug; (5) Pharmacists did not conduct medication feedback survey on patients; (6) Patients did not attach importance or thought it was unnecessary to receive medication guidance from pharmacists; (7) Physician′s prescription was wrong, resulting in overdose; (8) Doctors and patients did not communicate well, and patients did not know what medicine they were using; (9) Pharmacists did not fully understand drug information such as drug properties, prohibited population, interaction, medication time, etc.; (10) Pharmacists ignored the commonly used dose of the drug, applicable population, and other information in the process of reviewing the prescription. According to above-mentioned risk points, the risk intervention suggestions of IDeg were put forward, including the maintenance of basic drug information, the prescription of doctors, the dispensing of pharmacists, the patient medication link, the nurse administration link, the collection of medication error reports, and the strengthening of personnel training.Conclusion:The FMEA method can be used to effectively find out the risk points of medication errors in the clinical application of IDeg, the priority of IDeg risk management can be determined through quantitative evaluation, and corresponding preventive measures can be formulated.

Objective:To explore the risks of medication errors of insulin degludec (IDeg) in clinical application using failure mode and effect analysis (FMEA).Methods:A research group on the risk points of medication errors was established in the First Affiliated Hospital of Shandong First Medical University. The risk points of medication errors were collected through questionnaire survey, literature research, and on-the-spot investigation. The severity, frequency of occurrence, and likelihood of detection were scored to determine the risk priority number (RPN) and formulate corresponding preventive measures.Results:After comprehensive evaluation, 32 risk points were found in the 4 links of physician prescription, pharmacist dispensing, nurse administration, and patient medication. The RPN was ranked from high to low, and 10 key risk points (RPN>70 points) were selected. (1) The pharmacist did not give the patients guidance on the use of IDeg; (2) Patients did not know that they should actively report to the physicians about the use feeling and adverse reactions of the drug; (3) Patients did not clear about the content of medication monitoring; (4) Patients did not master how to use the drug; (5) Pharmacists did not conduct medication feedback survey on patients; (6) Patients did not attach importance or thought it was unnecessary to receive medication guidance from pharmacists; (7) Physician′s prescription was wrong, resulting in overdose; (8) Doctors and patients did not communicate well, and patients did not know what medicine they were using; (9) Pharmacists did not fully understand drug information such as drug properties, prohibited population, interaction, medication time, etc.; (10) Pharmacists ignored the commonly used dose of the drug, applicable population, and other information in the process of reviewing the prescription. According to above-mentioned risk points, the risk intervention suggestions of IDeg were put forward, including the maintenance of basic drug information, the prescription of doctors, the dispensing of pharmacists, the patient medication link, the nurse administration link, the collection of medication error reports, and the strengthening of personnel training.Conclusion:The FMEA method can be used to effectively find out the risk points of medication errors in the clinical application of IDeg, the priority of IDeg risk management can be determined through quantitative evaluation, and corresponding preventive measures can be formulated.

Objectives In order to provide valuable information for the diagnosis and treatment of allergic diseases,the prevalence and trend changes of common allergens in Beijing were investigated and analyzed.Methods This study was a retrospective data collection study.A total of 11 641 patients with allergen examinations were collected from Peking University First Hospital from 2013 to 2017.The positive rate of each allergen was counted according to age,season and year.The epidemiological characteristics and trends were analyzed.Results In the past five years,20 636 total IgE and 45 620 allergen-specific IgE were collected,and the total positive rate of total IgE was 47.8％ (9 874/20 636).The top three positive rates of inhaled allergens were Dermatophagoides farina (28.1％,509/1 812),Dermatophagoides pteronyssinus (26.8％,503/1 876) and Mugwort (24.7％,240/971).The top three positive rates of food allergen were egg (17.3％,188/10 88),milk (16.7％,186/1 114) and wheat (15.3％,127/829).The positive rate of inhaled allergens (phad as an example) increased year by year.The positive rate of food allergens (fx5 as an example) reached its peak in 2015 (16.3％,511/3 139) and decreased slightly in the last two years (2016:13.0％,571/ 4 396;2017:7.4％,330/4 461).In inhaled allergens,the positive rate of weed pollen increased significantly in autumn.The positive rates of mx2 and dust mites were higher in summer.Food allergen did not change significantly with the seasons.Conclusions This study shown the distribution of allergens in patients with allergic diseases to a certain extent.It provided epidemiological data and clinical evidence for the prevention and treatment of allergic diseases.