Objective To search,evaluate,and summarize the best evidence of insertion and maintenance of mini-midline in adult patients,in order to provide a solid evidence-based foundation for establishing clinical standardized and safe utilization of mini-midline.Methods We systematically searched UpToDate,BMJ Best Practice,Guideline International Network,National Guideline Clearinghouse,Joanna Briggs Institute,National Institute for Health and Care Excellence,Centers for Disease Control and Prevention,Scottish Intercollegiate Guidelines Network,Canadian Medical Association:Clinical Practice Guideline,Registered Nurses'Association of Ontario,Intravenous Nurses Society,Cochrane Library,PubMed,CINAHL,Embase,Web of Science,Yimaitong,China National Knowledge Infrastructure,Wanfang Database,and China Biomedical Literature Database.It includes clinical practice guidelines,expert consensuses,evidence summaries,systematic reviews,meta-analyses,and best practice on mini-midline insertion and maintenance.The search period covered January 2013 to May 2023.2 researchers independently evaluated the literature quality and extracted the literature that met the standards.The evidence was graded using the JBI evidence pre-grading system(2014),and the extracted evidence was classified and summarized by themes.Results A total of 10 pieces of the literature were involved,including 6 guidelines,2 expert consensuses,and 2 systematic reviews.This study summarized 20 pieces of best evidence in relation to the following 4 themes:indications and contraindications for mini-midline,catheter insertion,catheter maintenance and catheter removal.Conclusion The study comprehensively and scientifically summarizes the best evidence regarding the insertion and maintenance of mini-midline.We recommend that clinical practitioners integrate this evidence into their practice,while considering individual patient preferences and medical contexts.This approach,in line with the principle of individualization,will contribute to enhancing the standardization and safety of mini-midline use in clinical settings.

BACKGROUND:The anterior cruciate ligament has unique nonlinear mechanical properties under a complex physiological loading environment.Elastin is an important contributor to the mechanical properties of the anterior cruciate ligament,but its mechanical response to the anterior cruciate ligament under axial tension is not clear. OBJECTIVE:To quantitatively analyze the effect of elastin on the tensile mechanical response of the anterior cruciate ligament. METHODS:Elastase solution and control buffer were prepared.The porcine anterior cruciate ligament samples were prepared into small-size samples and randomly soaked in 0,0.1,1.0,2.0,5.0,and 10.0 U/mL elastase solution for 6 hours,and other small samples of the same size were soaked in 2 U/mL elastase solution for 0,1,3,6,9,and 12 hours.To determine suitable soaking conditions for elastin-targeted enzymes and verify the digestive effect,histological staining was used to compare the effects of enzyme treatment on tissue structure and composition.The ligament samples were randomly divided into elastase-treated group and PBS group,and immersed in 2 U/mL elastase solution and PBS buffer for 6 hours,respectively.A mechanical tensile test was performed before and after immersion. RESULTS AND CONCLUSION:(1)The biochemical results showed that being treated in 2 U/mL elastase solution for 6 hours could reduce the elastin content by 31.1%,and had no significant effect on other mechanical-related components in the tissue.(2)The histological results showed that elastase was able to penetrate the tissue,and the loose degree of tissue increased after treatment.(3)In the mechanical results before and after treatment,the mechanical properties of the PBS group decreased significantly,only the low-tension elastic modulus increased significantly and the initial length increased significantly in the elastase-treated group.(4)The intergroup comparison results showed that there was no significant difference between the two groups in pre-treatment,but the low-tension elastic modulus,initial slopes,saturated slopes,and initial length of the elastase-treated group after treatment were significantly higher than those in the PBS group.(5)These results suggest that elastin degradation significantly affects the biomechanical properties of the anterior cruciate ligament and further complements our understanding of the structure-function relationship of the anterior cruciate ligament.

This paper summarized professor WANG Shouchuan's experience in differentiating and treating children epistaxis from the perspective of "four excess and three deficiency". It is believed that the pathogenesis of children epistaxis is concluded as "four excess and three deficiency"， of which the four excess syndromes are exuberant heat in the lung channel， intense stomach fire， heart fire hyperactivity， and liver fire flaming upward， while the three deficiency syndromes include qi， yin and yang deficiency. Seven methods for treating children epistaxis are summarized. For exuberant heat in the lung channel syndrome， it is recommended to clear lung and direct qi downward， using self-made Xiebai Zhiniu Decoction （泻白止衄汤）. For intense stomach fire syndrome， the method of clearing stomach and draining fire can be used with self-made Qingwei Zhiniu Decoction （清胃止衄汤）. In terms of heart fire hyperactivity syndrome， it is better to clear heart and drain fire， using self-made Daochi Zhiniu Decoction （导赤止衄汤）. For liver fire flaming upward syndrome， it is advised to clear liver and drain fire， using self-made Yimu Zhiniu Decoction （抑木止衄汤）. In terms of qi deficiency syndrome， the method of fortifying spleen and boosting qi and containing blood should be used with self-made Futu Zhiniu Decoction （扶土止衄汤）. If there is yin deficiency syndrome， it is advised to supplement kidney， enrich yin and clear heat， using self-made Zishui Zhiniu Decoction （滋水止衄汤）. If there is yang deficiency syndrome， the method of boosting qi， warming yang and nourishing blood can be used， using self-made Wenpi Zhiniu Decoction （温脾止衄汤）.

OBJECTIVE To investigate the potential therapeutic effect of the sporoderm-removed Ganoderma lucidum spore tablet "Xianzhi No.3" from the perspective of immunomodulation and cardioprotection. METHODS Chemical components of the sporoderm-removed Ganoderma lucidum spore tablet "Xianzhi No.3" were analyzed by UPLC-Q-TOF-MS and colorimetric methods. Examined tablet’s effects on zebrafish models of macrophage reduction, heart failure, H2O2-induced oxidative stress in myocardial and endothelial cells, and a microglial inflammation model induced by lipopolysaccharide. Immune regulation and cardioprotective effects were evaluated through multiple indicators, including macrophage formation and phagocytosis abilities, anti-neuroinflammation ability, cardiac systolic and diastolic functions, and anti-oxidative stress injury ability in myocardial and endothelial cells. RESULTS The sporoderm-removed Ganoderma lucidum spore tablet "Xianzhi No.3" improved macrophage formation and phagocytosis, cardiac systolic and diastolic functions, reduced neuroinflammation, and alleviated oxidative stress in myocardial and endothelial cells, resulting in immunomodulatory and cardioprotective effects. CONCLUSION The sporoderm-removed Ganoderma lucidum spore tablet "Xianzhi No.3" maybe a potential therapeutic agent for regulating the immune system and protecting cardiac function.

Objective To investigate the characteristics and clinicopathology of v-raf murine sarcoma viral oncogene homolog Bl(BRAF)V600E mutations in papillary thyroid carcinoma(PTC)in Air Force flight personnel.Methods Data of cases and test results of BRAF V600E mutation were collected from Air Force aviators pathologically diagnosed with PTC.A univariate analysis of the relationship between BRAF V600E mutations and clinicopathologic features was performed.Results The overall rate of BRAF V600E mutations among 55 PTC flight crew members was 70.91％.The univariate analysis showed that the number of lymph node metastases in the BRAF V600E mutated group was larger than in the BRAF V600E unmutated group,and the proportion of BRAF V600E mutations in flight crews at intermediate risk of recurrence was higher than that in those at low risk of recurrence(P＜0.05).The presence or absence of BRAF V600E mutations did not affect the results of medical evaluation of PTC in flight personnel.Conclusion The rate of PTC BRAF V600E mutations in Air Force flight crews is similar to that of the general Chinese population.BRAF V600E mutations are associated with an increased number of lymph node metastases and risk of recurrence,and follow-up is recommended for flight personnel with PTC,especially those with BRAF V600E mutations.

Objective:To analyze the expression level of hepcidin in urine of patients with type 2 diabetic kidney disease (DKD) in different stages and its relationship with DKD and related indicators.Methods:From June 2022 to December 2023, 139 inpatients with type 2 diabetes mellitus in the Department of Endocrinology, Zhoupu Hospital Affiliated to Shanghai Health Medical College were selected as the research objects. The stage of DKD was judged by urinary albumin/creatinine ratio (UACR): UACR <30 mg/g in stage A1, UACR ≥30 mg/g~≤300 mg/g in stage A2. DKD in stage A3 was UACR >300 mg/g. According to the stage of DKD, there were 50 patients with stage A1 (group A1), 47 patients with stage A2 (group A2), and 42 patients with stage A3 (group A3). Urinary hepcidin was determined by enzyme-linked immunosorbent assay, and fasting blood glucose, total cholesterol, triglyceride, alanine aminotransferase (ALT), serum creatinine and hemoglobin A1c (HbA1c) were measured and compared. The correlation between urinary hepcidin and other markers, the risk factors of DKD and the evaluation of diagnostic value were analyzed. Measurement data with normal distribution were expressed as xˉ± s, mean comparison among the three groups, if the variance was homogeneous, the analysis of variance test was used; if the variance was not homogeneous, the Welch test was used; the proportion or rate of enumeration data among the groups was tested by χ2 test; Pearson correlation analysis was used for correlation analysis; binary Logistic regression model was used for multivariate analysis; The value of urinary hepcidin in the diagnosis of DKD was analyzed by receiver operating characteristic curve. Results:Urinary hepcidin was (5.3±1.0) μg/L in group A1, (7.7±2.5) μg/L in group A2, and (10.1±2.7) μg/L in group A3. There was significant difference among the three groups ( F=58.92， P<0.001), and urinary hepcidin increased with the severity of DKD; Urinary Hepcidin was related to UACR ( R=0.684, P<0.001), serum creatinine ( R=0.590, P<0.001), course of disease ( R=0.485, P<0.001), triglyceride ( R=0.264, P=0.002), age ( R=0.235, P<0.001), P=0.005), total cholesterol ( R=0.224, P=0.008), systolic pressure ( R=0.194, P=0.022), glomerular filtration rate ( R=-0.540, P<0.001) and BMI ( R=-0.175, P=0.040); There was no correlation with fasting blood glucose, HbA1c, ALT and diastolic blood pressure (all P>0.05). Secondly, the increase of urinary hepcidin level was a risk factor for DKD by binary Logistic regression analysis ( OR=4.147,95% CI: 2.154-7.984, P<0.001). Finally, receiver operating characteristic curve analysis showed that the optimal cut-off point of urinary hepcidin was 6.35 μg/L, with a sensitivity of 0.831 and a specificity of 0.880. Conclusion:Urinary hepcidin increases with the severity of DKD, which may be a biomarker for early diagnosis of DKD.

Objective To explore the clinical application value of emergency bedside echocardiography(EB-Echo)in the diagnosis and treatment of reverse-Takotsubo syndrome(r-TTS).Methods A retrospective study method was conducted,the EB-Echo imaging and clinical data of 10 patients already diagnosed with r-TTS and admitted to the department of critical care medicine of Zhengzhou People's Hospital from January 2014 to December 2021 were selected.The r-TTS group,while data from 33 concurrently admitted patients with classic Takotsubo syndrome(TTS)were selected as the classic TTS group.Comparisons were made in terms of EB-Echo detection rates,diagnosis times,cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular stroke volume(LVSV)],blood volume indicators[inferior vena cava diameter(IVCD),collapse degree of inferior vena cava(cIVC)],complications[acute left ventricular outflow tract obstruction(ALVOTO),acute mitral regurgitation(AMR),and pulmonary hypertension(PH)],and prognosis between the two groups.Results The detection rate of EB-Echo in the r-TTS group was significantly higher than that in the classic TTS group[100.0%(10/10)vs.66.7%(22/33),P<0.05],and the diagnosis time was significantly shorter(minutes:26.80±3.77 vs.41.18±6.61,P<0.05).In terms of cardiac function indicators,both LVEF and LVSV were significantly lower in the r-TTS group compared to the classic TTS group[LVEF:0.36±0.05 vs.0.41±0.04,LVSV(mL):36.43±4.30 vs.40.65±5.09,both P<0.05].However,there were no significant differences in blood volume indicators(IVCD and cIVC)between the r-TTS group and the classic TTS group[IVCD(mm):15.02±1.88 vs.14.94±1.75,cIVC:(0.43±0.06)%vs.(0.44±0.07)%,both P>0.05].Concerning complications,the incidence of ALVOTO was slightly lower in the r-TTS group compared to the classic TTS group[0%(0/10)vs.21.2%(7/33),P>0.05],while the incidences of AMR and PH were similar between the two groups[AMR incidence:40.0%(4/10)vs.24.2%(8/33),PH incidence:30.0%(3/10)vs.18.2%(6/33),both P>0.05].After a follow-up ranging from 6 months to 3 years,no deaths were reported in the r-TTS group,whereas there was one fatality in the classic TTS group.Nevertheless,the mortality difference between the groups was not statistically significant.Conclusion EB-Echo demonstrates significant clinical value in the early diagnosis,guiding therapy,and enhancing prognosis of r-TTS.

Objective:To investigate the efficacy and safety of Enterprise stenting in the treatment of symptomatic middle cerebral artery atherosclerotic stenosis.Methods:Patients with symptomatic middle cerebral artery atherosclerotic stenosis underwent Enterprise stenting in the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2020 to December 2022 were retrospectively included. The degree of residual stenosis, periprocedural complications, in-stent restenosis and stroke recurrence during follow-up were evaluated.Results:A total of 75 patients were enrolled, including 55 males (73.3%), aged 58±9.7 years. The last preprocedural symptom was stroke in 65 cases (86.7%) and transient ischemic attack in 10 cases (13.3%). Sixty-seven patients (89.3%) had the M1 segment stenosis of the middle cerebral artery, and 8 (10.7%) had the M2 segment stenosis. The degree of stenosis was 88.4%±8.90%. The median time from the last onset to stenting was 18 days (interquartile range, 13-24 days). The procedural success rate was 100%, and the residual stenosis degree was 17.3%±6.1%. Four patients (5.3%) experienced periprocedural complications, including three ischemic strokes and one symptomatic intracranial hemorrhage. Sixty-one patients (81.3%) completed 3- to 12-month follow-up, of which 7 patients (11.5%) had in-stent restenosis and 2 (3.3%) had recurrent ischemic stroke.Conclusion:Enterprise stenting may be safe and effective in the treatment of symptomatic middle cerebral artery stenosis.

This article introduced the background,drafting process,and main content of the Interim Measures for the Management of Surplus Drugs in Medical Institutions of Hubei Province(referred as the Measures).It focused on explaining the definition of surplus drugs and analyzing the requirements for drug dismantling,surplus drug billing,recovery and use procedures,special fund management,and duties and responsibilities of management departments.This paper aimed to guide readers to learn the Measures,understand the Measures and implement the Measures.It would help to improve the efficiency of medical resources,ensure medication safety,reduce patients'medication burden,and promote the rational use of medical insurance funds.

OBJECTIVE To study the immunomodulatory effect of Guipi pills on D-galactose（D-gal）-induced aging mice. METHODS The immune-related targets and related pathways for Guipi pills to exert immune effects were screened by network pharmacology and verified through pharmacodynamic experiments. Totally 105 male ICR mice were randomly divided into blank control （CON） group， model control （MOD） group， positive control （POS） group， Guipi pills low-dose （GD） group and Guipi pills high-dose （GG） group. Except for the CON group， other groups were subcutaneously injected with 400 mg/kg D-gal to induce the aging model； CON group and MOD group were given distilled water， POS group was given 300 mg/kg pidotimod oral solution intragastrically， GD group and GG group were given Guipi pills 300， 600 mg/kg intragastrically， once a day， for 8 weeks. After medication， the serum and spleen were collected， and the contents of interleukin 2 （IL-2）， IL-4， IL-6 and tumor necrosis factor α （TNF-α）， and the contents of immunoglobulin G （IgG）， IgM and IgA were detected. The spleen index was calculated and the histopathological changes in the spleen were observed. The activities of superoxide dismutase （SOD）， glutathione peroxidase （GSH- Px） and malondialdehyde （MDA）， and the content of 8-hydroxy-2 deoxyguanosine （8-OHdG） in spleen were detected； the expression of TNF/phosphoinositide-3-kinase-threonine protein kinase （PI3k-Akt）-related proteins in spleen was detected except for POS group. RESULTS The results of network pharmacology showed that TNF， IL-6 and Akt1 were core targets. The results of pharmacodynamic study showed that compared with MOD group， the contents of IL-2， IL-4， IgG， IgM and IgA were increased significantly in Guipi pills groups， while the contents of TNF-α and IL-6 were decreased significantly； the spleen index was increased significantly （P＜0.05 or P＜0.01）. The phenomenon of diffuse proliferation of lymphocytes was improved， the spleen cells were closely arranged， and the line between the white pulp and red pulp was clear. The activities of SOD and GSH-Px in spleen were increased significantly， while the activity of MDA， the content of 8-OHdG， and the protein expressions of TNF-α， PI3K and p-Akt were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS Guipi pills can regulate the immune function of D-gal-induced aging mice， which is related to regulating the TNF/PI3k-Akt pathway， thereby reducing oxidative stress damage in spleen tissue of mice， and regulating protein expressions of TNF-α， PI3K and p-Akt.