Guided by Academician Zhang Boli's theory of "dampness， turbidity， phlegm， and fluid-related diseases"，this paper elaborated on the pathogenesis and syndrome differentiation treatment of heart failure from the perspective of the "spleen-mitochondria". It analyzed the essential similarities between "spleen-mitochondria" and "dampness， turbidity， phlegm， and fluid-related diseases"， as well as their close association with the onset of heart failure. Furthermore，it explored the connection between spleen function and mitochondrial function in traditional Chinese medicine （TCM），positing that the spleen's role in transportation and transformation is analogous to mitochondrial material metabolism and energy conversion，with spleen deficiency closely related to mitochondrial dysfunction. It thus concluded that mitochondrial material metabolism and energy conversion represent the microscopic essence of the spleen's role in transportation and transformation，and mitochondrial dysfunction is a contributing factor to pathological products like dampness and turbid phlegm，which are closely associated with the occurrence of heart failure. The four elements of dampness，turbidity，phlegm，and fluid are a series of related symptoms resulting from abnormal fluid transportation and transformation，serving as both factors in the onset of heart failure and the core pathological basis for its deterioration. Therefore，during the treatment of heart failure，it is essential to regulate mitochondrial function. Early intervention should focus on eliminating dampness and turbidity to improve mitochondrial function and restore normal energy metabolism. In the middle and late stages，emphasis should be placed on resolving phlegm，promoting blood circulation，warming Yang，and reducing water retention to alleviate mitochondrial damage and improve cardiac function. Supporting Qi and strengthening the spleen should be a continuous approach，and treatment should be adjusted to enhance mitochondrial function and stabilize the condition，thereby improving prognosis. This paper discussed the role of the spleen and mitochondria in the pathogenesis of heart failure，examined the evolution of heart failure mechanisms from the perspective of dampness， turbidity， phlegm， and fluid-related diseases，and proposed a phased treatment strategy. It enriched the theory of dampness， turbidity， phlegm， and fluid-related diseases and offered new strategies for heart failure treatment. However，in practical application，TCM strategies for treating heart failure need to be integrated with modern medical approaches to provide a more solid scientific foundation for treatment.

Myocardial fibrosis （MF）， characterized by decreased cardiac function and myocardial compliance， is a pathological process and a progression factor in various cardiovascular diseases. The nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 （NLRP3） inflammasome is closely related to the development of MF. Recent studies have shown that traditional Chinese medicine （TCM） can regulate the NLRP3 inflammasome to alleviate MF. Based on this， this article systematically summarizes the research progress on the mechanisms by which TCM regulates the NLRP3 inflammasome to improve MF. It is found that active ingredients of TCM， such as alkaloids （lycorine，vincristine，bufalin）， saponins （astragaloside Ⅳ， diosgenin，ginsenoside Rg3）， terpenoids （celastrol，oridonin）， and phenols （polydatin，curcumin，phloridzin） as well as TCM formulas （Zhachong shisanwei pills，Zhilong huoxue tongyu capsules， Luqi formula） can inhibit the activation of the NLRP3 inflammasome， thereby suppressing the release of inflammatory factors such as interleukin-1β and IL-18， reducing inflammatory damage to myocardial tissue， alleviating excessive deposition of the extracellular matrix， and thus exerting the effect of improving MF.

Objective:To explore the evaluation effect of ultrasonography and Pirani score on tarsal deformity, treatment effect and pseudo-correction of congenital clubfoot in infants and young children, and the correlation between the two methods.Methods:This is a retrospective case series study. The clinical data of 26 children (40 feet) with congenital clubfoot who were evaluated by ultrasonography in the Third Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected. There were 16 males and 10 females. The age at the first ultrasound examination was ( M(IQR)) 9.0 (18.0) days (range: 1 to 46 days). All patients were treated with Ponseti method by the same physician. The Pirani scores before and after treatment and at the last examination, and the talonavicular angle, calcaneocuboid angle and tibiocalcaneal angle measured by ultrasound were collected, and the treatment and follow-up were recorded. Paired sample t test, repeated measures analysis of variance or Kruskal-Wallis test were used for data comparison, and Spearman correlation analysis was used for correlation analysis. The receiver operating characteristic curve was used to calculate the efficacy of ultrasound in evaluating different Pirani scores. Results:The number of plaster fixation in 26 children was 4.0 (1.0) times (range: 2 to 8 times). The medial talonavicular angle and posterior tibiocalcaneal angle were significantly improved after treatment and at the last follow-up compared with those before treatment, and the differences were statistically significant (all P<0.01). There was no difference in lateral calcaneocuboid angle before and after treatment and at the last follow-up ( F=1.971, P>0.05). Pseudo-correction occurred in 2 cases (2 feet) during the treatment, with an incidence of 5%. Correlation analysis showed that there was a moderate positive correlation between talonavicular angle and Pirani midfoot score ( r=0.480, P<0.01). There was no correlation between calcaneocuboid angle and Pirani midfoot score ( r=0.114, P=0.105). There was a moderate negative correlation between tibial heel angle and Pirani hindfoot score ( r=-0.566, P<0.01). The cut-off point of Pirani midfoot score of 1.5 was 38.78°, the sensitivity was 0.90, the specificity was 0.56, and the area under the curve was 0.75. The cut-off value of angle was 27.51 °, the sensitivity was 0.16, the specificity was 0.92, and the area under the curve was 0.44.The cut-off points of Pirani midfoot score of 3.0 were 45.08°and 9.96°, the sensitivity was 0.94 and 0.91, the specificity was 0.37 and 0.42, and the area under the curve was 0.59 and 0.62, respectively. The cut-off values of Pirani hindfoot score of 2.0 and 3.0 were 167.46° and 160.15°, respectively. The sensitivity was 0.75 and 0.67, the specificity was 0.81 and 0.83, and the area under the curve was 0.78 and 0.71, respectively. Conclusion:Ultrasound can complement with Pirani score, visually and dynamically observe the morphology and position changes of talonavicular joint, calcaneocuboid joint and tibiotalocalcaneal joint, monitor the recovery and pseudo-correction of tarsal bones, and better evaluate the therapeutic effect.

Objective To construct early phase Ⅰ cardiopulmonary rehabilitation program for patients with Type A aortic dissection and to evaluate its clinical effects.Methods From January 2021 to October 2022,type A aortic dissection patients of a tertiary hospital in Beijing was selected by the destination sampling.They were divided into a control group and an intervention group.The intervention group was given early phase Ⅰcardiopulmonary rehabilitation program for patients with type A aortic dissection and the control group was given routine care.The 6-minute walking experiment(6MWT),Borg subjective fatigue score,the first time out of bed,the incidence of hypoxemia and related complications,and the incidence of adverse events related to rehabilitation nursing were compared between the 2 groups.Results A total of 130 cases were selected,among which 20 cases were excluded because of surgical complications and self-withdrawal.A total of 110 cases were finally included,with 57 cases in the intervention group and 53 cases in the control group.The results of walking distance of 6MWT,Borg subjective fatigue score and incidence of hypoxemia had statistical significance between the 2 groups(P＜0.05).The results of the time of the first time out of bed and the incidence of complications and the incidence of adverse events related to rehabilitation nursing had no statistical significance between the 2 groups(P＞0.05).Conclusion Early phase Ⅰ cardiopulmonary rehabilitation program for patients with type A aortic dissection benefits the improvement of the motor function,the reduction of incidence of hypoxemia.

Background and purpose:In 2016 the National Cancer Institute(NCI)decided stopping to use NCI-60 cell lines for drug screening,suggesting that tumor cell lines were losing their value as a tool for drug discovery and basic research.The reason for NCI-60 cells'retirement'was that the preclinical studies based on traditional cellular and animal models did not obtain the corresponding expected efficacy in clinical trials.Since the major cancer behaviors,such as proliferation and metastasis,are fundamentally altered with long-term culture,the tumor cell lines are not representative of the characteristics of cancer in patients.Currently,scientists hope to create a new cancer model that are derived from fresh patient samples and tagged with details about their clinical past.Our purpose was to create patient-derived breast cancer primary cell lines as new cancer model for drug screening and basic research.Methods:Breast cancer tissues were collected in the Department of Breast Surgery,Affiliated Hospital of Guizhou Medical University.The collection of tumor tissue samples was approved by the Ethics Committee of the Affiliated Hospital of Guizhou Medical University(approval number:2022 ethics No.313),and the collection and use of tumor tissues complied with the Declaration of Helsinki.The primary breast cancer cell lines were isolated from the patient's breast cancer tissues and cultured in BCMI medium.After the cells proliferated,the media were replaced with DEME medium.Cell line STR genotyping was done to determine cell-specific genetic markers and identification.Clone formation assay and transplantation assay were done to analyze the ability of breast cancer primary cell lines to form tumors.Results:We created 6 primary breast cancer cell lines.The 6 primary breast cancer cell lines from the patients were tagged with the definitively clinicopathological features,clinical diagnosis,therapeutic regimens,clinical effectiveness and prognostic outcomes.The STR genotyping assays identified the genetic markers and determined the identities of the 6 primary breast cancer cell lines.Clone formation assays and transplantation assay showed that the proliferative capacities of the patient-derived primary breast cancer cell lines were significantly greater compared with the conventional breast cancer cell lines.Conclusion:We created a panel of 6 patient-derived primary breast cancer cell lines as new cancer model for drug screening and basic research in breast cancer.

Objective:To explore the evaluation effect of ultrasonography and Pirani score on tarsal deformity, treatment effect and pseudo-correction of congenital clubfoot in infants and young children, and the correlation between the two methods.Methods:This is a retrospective case series study. The clinical data of 26 children (40 feet) with congenital clubfoot who were evaluated by ultrasonography in the Third Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected. There were 16 males and 10 females. The age at the first ultrasound examination was ( M(IQR)) 9.0 (18.0) days (range: 1 to 46 days). All patients were treated with Ponseti method by the same physician. The Pirani scores before and after treatment and at the last examination, and the talonavicular angle, calcaneocuboid angle and tibiocalcaneal angle measured by ultrasound were collected, and the treatment and follow-up were recorded. Paired sample t test, repeated measures analysis of variance or Kruskal-Wallis test were used for data comparison, and Spearman correlation analysis was used for correlation analysis. The receiver operating characteristic curve was used to calculate the efficacy of ultrasound in evaluating different Pirani scores. Results:The number of plaster fixation in 26 children was 4.0 (1.0) times (range: 2 to 8 times). The medial talonavicular angle and posterior tibiocalcaneal angle were significantly improved after treatment and at the last follow-up compared with those before treatment, and the differences were statistically significant (all P<0.01). There was no difference in lateral calcaneocuboid angle before and after treatment and at the last follow-up ( F=1.971, P>0.05). Pseudo-correction occurred in 2 cases (2 feet) during the treatment, with an incidence of 5%. Correlation analysis showed that there was a moderate positive correlation between talonavicular angle and Pirani midfoot score ( r=0.480, P<0.01). There was no correlation between calcaneocuboid angle and Pirani midfoot score ( r=0.114, P=0.105). There was a moderate negative correlation between tibial heel angle and Pirani hindfoot score ( r=-0.566, P<0.01). The cut-off point of Pirani midfoot score of 1.5 was 38.78°, the sensitivity was 0.90, the specificity was 0.56, and the area under the curve was 0.75. The cut-off value of angle was 27.51 °, the sensitivity was 0.16, the specificity was 0.92, and the area under the curve was 0.44.The cut-off points of Pirani midfoot score of 3.0 were 45.08°and 9.96°, the sensitivity was 0.94 and 0.91, the specificity was 0.37 and 0.42, and the area under the curve was 0.59 and 0.62, respectively. The cut-off values of Pirani hindfoot score of 2.0 and 3.0 were 167.46° and 160.15°, respectively. The sensitivity was 0.75 and 0.67, the specificity was 0.81 and 0.83, and the area under the curve was 0.78 and 0.71, respectively. Conclusion:Ultrasound can complement with Pirani score, visually and dynamically observe the morphology and position changes of talonavicular joint, calcaneocuboid joint and tibiotalocalcaneal joint, monitor the recovery and pseudo-correction of tarsal bones, and better evaluate the therapeutic effect.

Objective:To investigate the clinicopathological features and molecular characteristics of β-catenin-deficient colorectal cancer.Methods:The clinical, pathological and molecular features of 11 colorectal cancers with β-catenin protein loss diagnosed at the 960th Hospital of People′s Liberation Army of China, from January 2012 to November 2022 were analyzed.Results:Among the 11 patients, 3 were males and 8 were females. Their age ranged from 43 to 74 years, with the median age of 59 years. Six were in the left colon and 5 were in the right colon. One of the 11 cases had lymph node metastasis, 10 cases were well and moderately differentiated adenocarcinoma, and 1 was mucinous adenocarcinoma. Eight cases were of TNM stage T4, 2 of T1 stage and 1 of Tis stage. β-catenin protein was not detected using immunohistochemistry. Sanger sequencing revealed the presence of fragment-deletion mutation in exon 3 of CTNNB1 gene, resulting in loss of β-catenin protein expression.Conclusion:β-catenin deficiency is present in a small number of colorectal cancers and may be associated with exon 3 mutations of CTNNB1 gene.

Fusarium is a kind of conditional pathogenic fungus. There are few reports of peritonitis caused by Fusarium at home and abroad. This paper reports a case of Fusariumverticillioides peritonitis complicated with bacteremia and reviews relevant literature. The patient was admitted to the hospital due to fever and abdominal pain. After peritonitis was diagnosed, the initial treatment was vancomycin plus ceftazidime kept in the abdominal cavity every night for 3 days, but the effect was not good. The antibiotic was upgraded to vancomycin plus meropenem for 2 days, but still, there was no effect. Subsequently, Fusarium was found after ascites fluid culture, and the treatment regimen was changed to voriconazole antifungal therapy and hemodialysis. However, the patient developed a dialysis catheter-related infection. After the infection was cured, the fever was still repeated, and the infection indexes did not improve. Further, the pathogenic microorganism of whole blood infection was detected by high-throughput gene detection, and it was clinically confirmed as Fusarium verticillioides. At last, the patient recovered and was discharged from the hospital after treatment with voriconazole combined with amphotericin B. Fusarium is highly pathogenic, and it is hoped to attract more attention of clinicians.

Objective:To systematically review the impact of resistance training on body weight and body composition in breast cancer patients.Methods:Randomized controlled trials of the impact of resistance training on body weight and body composition in breast cancer patients were searched through computers in Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) , China Biomedical Literature Database, VIP and WanFang Data. The search period was from the establishment of the database to April 20, 2022. Two researchers independently screened the article, evaluated the quality of the article, and extracted the data. Meta-analysis was conducted using RevMan 5.4 software.Results:A total of 11 articles were included, including 1 077 patients with breast cancer. Meta-analysis results showed that resistance training could reduce body fat rate [ SMD=-1.21, 95% CI (-1.92, -0.50) , P<0.01] , fat mass [ SMD=-0.64, 95% CI (-1.13, -0.14) , P<0.01] , and increase lean body weight [ SMD=1.31, 95% CI (0.54, 2.07) , P<0.01] in breast cancer patients compared with conventional nursing or flexibility training, but there was no statistical difference in the impact on body weight ( P>0.05) . Conclusions:Resistance training can improve the body composition, and has positive impacts on the body weight and body composition in breast cancer patients.

Objective:To compare the effects of different lung recruitment maneuvers in infants undergoing laparoscopic surgery.Methods:A total of 70 pediatric patients of either sex, aged 1-6 yr, weighing 10-24 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective laparoscopic surgery from September 2020 to June 2021 with expected operation time≤2 h, were divided into 2 groups ( n=35 each) by a random number table method: recruitment maneuver using incremental positive end-expiratory pressure (PEEP) group (PV group) and recruitment maneuver using controlled lung expansion group (RM group). The children underwent pressure-controlled ventilation after tracheal intubation, and lung recruitment was performed at 20 min after pneumoperitoneum, immediately after pneumoperitoneum, and at the end of operation and before tracheal extubation.In PV group, PEEP was gradually increased, the upper limit of airway pressure was 35 mmHg, PEEP was increased by 5 cmH 2O, ventilation was performed for 30 s, then PEEP was increased to 15 cmH 2O, ventilation was continued for 30 s, then the parameters were adjusted to the original ones, and ventilation was continued until the next lung recruitment.In RM group, manual ventilation mode was used, the pressure valve was adjusted to 30 cmH 2O, the pressure was increased to the maximum by rapid oxygenation, the breathing cuff was manually squeezed until the airway pressure achieved 30-35 mmHg, and 30 s later ventilation was performed with the original ventilation parameters, lasting for 30 s until the next lung recruitment.Peak airway pressure and mean airway pressure were recorded at 5 min after tracheal intubation (T 1), 20 min after pneumoperitoneum (T 2), immediately after pneumoperitoneum (T 3) and before extubation after surgery (T 4), and dynamic lung compliance was calculated.Blood gas analysis was performed at T 2 and T 4, and arterial partial pressure of oxygen and arterial partial pressure of carbon dioxide were recorded, oxygenation index, alveolar-arterial oxygen partial pressure difference and respiratory index were calculated.Lung ultrasonography scores were assessed before tracheal extubation (T 0) and at T 4 and 20 min after entering the postanesthesia care unit (T 5). The time of tracheal extubation and length of postoperative hospital stay were recorded.Hypoxemia in postanesthesia care unit and occurrence of pulmonary complications within 3 days after operation were recorded. Results:Compared with RM group, peak airway pressure and mean airway pressure were significantly decreased at T 2, 3, dynamic lung compliance was increased at T 2-4, arterial partial pressure of oxygen and oxygenation index were decreased , arterial partial pressure of carbon dioxide, alveolar-arterial oxygen partial pressure difference and respiratory index were increased at T 2 and T 4, lung ultrasonography scores were decreased at T 4 and T 5, and the incidence of postoperative hypoxemia was increased, and tracheal extubation time was prolonged in RM group ( P<0.05). Conclusions:Lung recruitment maneuver using incremental PEEP provides better efficacy than that using controlled lung expansion in infants undergoing laparoscopic surgery.