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 analyze the passive smoking exposure and its influencing factors in non-smokers aged≥18 in Tianjin.Methods:This was a cross-sectional study. Based on the 2018 Tianjin Adults Noncommunicable Disease and Nutrition Surveillance, non-smokers aged≥18 years old at 7 surveillance sites were selected as the research objects, taking 2018 population data of Tianjin as the standard population, the sample data were weighted to analyze the general demographic characteristics, the level of passive smoking exposure, the cognition of tobacco harm, and the influencing factors of passive smoking exposure. Pearson χ 2 test was used to compare the rate between groups, and the influencing factors were analyzed by unconditional logistic regression. Results:After weighted, the passive smoking exposure rate was 51.5%, among non-current smokers, the awareness rates of smoking related lung cancer and passive smoking related adult lung cancer were 83.3% and 80.0%, respectively. The awareness rates of smoking related stroke and passive smoking related heart disease in adults were 61.4% and 66.4%, respectively. The awareness rate that smoking related stroke was higher in the non-passive smoking exposed group than in the secondhand smoke exposed group (62.7% vs 60.3%, P<0.05). There was no statistical difference in the awareness rate of smoking related heart attacks and lung cancer as well as passive smoking related adult heart disease, adult lung cancer, and lung disease in children between the passive smoking exposed group and the non-passive smoking exposed group (all P>0.05). The awareness rate of smoking related three diseases (stroke, heart attack and lung cancer) was 57.9% and the awareness rate of passive smoking related three diseases (heart disease in adults, lung cancer and lung disease in children) was 64.9% in non-current smokers. Among men, undergraduate or above was a protective factor for second-hand smoke exposure. Heads, clerical and related personnel of state organs, party and mass organizations, enterprises and public institutions were risk factors for secondhand smoke exposure. Among women, age ≥60 years and high education were protective factors for secondhand smoke exposure. Conclusions:Non smokers aged 18 and above in Tianjin have a higher level of passive smoking exposure, and the awareness rate of tobacco exposure related cardiovascular diseases is low. In future, the health education of relevant knowledge should be strengthened.

Objective To investigate the value of magnetic resonance imaging-proton density fat fraction(MRI-PDFF)in evaluating hepatic steatosis in patients with chronic hepatitis B virus(HBV)infection.Methods The patients,aged>16 years,who visited the outpatient service or were hospitalized in Beijing Tsinghua Changgung Hospital from January 2018 to December 2022 and were diagnosed with chronic HBV infection were enrolled,and all patients underwent MRI examination of the liver in our hospital.The patients were divided into groups based on the presence or absence of liver cirrhosis,and the consistency in PDFF between different hepatic segments was compared between groups.The Kappa consistency test and intraclass correlation coefficient(ICC)were used for consistency analysis.Results A total of 76 patients treated with nucleoside analogues were enrolled,among whom 23(30.26％)had liver cirrhosis.For all patients,the simple arithmetic average of PDFF fluctuated between 1.49％and 30.93％.According to MRI-PDFF≥5％as the diagnostic criterion for fatty liver disease,there were 29 patients(38.16％)with fatty liver disease among all patients.For all 76 patients,the simple arithmetic average of PDFF was lower than the weighted average of PDFF for the whole liver,and there was no significant difference between the simple arithmetic average of PDFF,the weighted average of PDFF,and the PDFF values of the left and right lobes of the liver(F=0.39,P=0.76).The consistency test showed that the PDFF values of each hepatic segment and the left and right lobes of the liver had strong consistency with the weighted average and simple arithmetic average of PDFF,with an ICC of>0.75,but the consistency between the PDFF value of the right lobe and the weighted average of PDFF was higher than that between the PDFF value of the left lobe and the weighted average of PDFF.In the consistency test of differentiating fatty liver disease in patients with liver cirrhosis,there was poor consistency between the PDFF value of segment Ⅶ and the weighted average of PDFF(Kappa=0.39),with moderate consistency for the left lobe and the Ⅰ,Ⅱ,Ⅲ,Ⅴ,Ⅵ,and Ⅷ segments.For the patients with liver cirrhosis,the lowest consistency was observed between the PDFF value of Ⅶ segment and the weighted average of PDFF for the whole liver,and the highest consistency was observed between the PDFF value of Ⅵ segment and the weighted average of PDFF for the whole liver.For the patients without liver cirrhosis,the lowest consistency was observed between the PDFF value of Ⅱ segment and the weighted average of PDFF for the whole liver,and the highest consistency was observed between the PDFF value of Ⅴ segment and the weighted average of PDFF for the whole liver.Conclusion MRI-PDFF is more comprehensive in evaluating hepatic steatosis in patients with chronic HBV infection,and for the patients with liver cirrhosis,there is poor consistency between the PDFF value of each segment and the weighted average of PDFF.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective To study the influencing factors of postoperative recurrence of vocal cord leukoplakia and establish a clinical prediction model.Methods A total of 386 patients with vocal cord leukoplakia treated in our hospital from February 2016 to February 2020 were selected retrospectively.According to the follow-up results,the patients were divided into two groups:recurrent group(n=89)and non-recurrent group(n=297).The general and clinical data of the two groups were collected.The influencing factors of postoperative recurrence of vocal cord leu-koplakia were screened by univariate analysis and Logistic regression analysis,and the Logistic risk prediction model was established.The model was internally verified by R software and boostrap method.Results Age(OR=0.924),drinking history(OR=1.946),voice abuse(OR=2.436),laryngopharyngeal reflux(OR=0.487),mod-erate dysplasia(OR=0.420)and severe dysplasia(OR=0.303)were the influencing factors of postoperative recur-rence of vocal cord leukoplakia.The internal verification AUC of the model was 0.777,95％the confidence interval was 0.663～0.825,and the model fit well.Conclusion The postoperative recurrence of vocal cord leukoplakia is related to the patient's age,leukoplakia range,pathological morphology and laryngopharyngeal reflux.

Objective:To generally evaluate the evaluation tools of post-stroke depression (PSD).Methods:Eight Chinese and English databases were retrieved, with a search deadline from the database establishment until December 31, 2022. Based on the theoretical framework of scope review, the relevant information was extracted and search results were analyzed.Results:44 articles were included, 20 of which were for the development of evaluation tools, and 24 were for the reliability, validity, sensitivity, and specificity tests of evaluation tools.Conclusions:At present, specific evaluation tools for patients with PSD have been available, but there is a lack of reliability and validity tests. In the future, the tests of specific evaluation tools should be strengthened. When choosing non-specific evaluation tools, high sensitivity evaluation tools should be selected. The evaluation results are influenced by many factors, and when selecting evaluation tools, it is necessary to generally evaluate factors such as the conditions of tool use, evaluator, and patient's own conditions.

Objective:To summarize the key prenatal ultrasound diagnosis features of Apert syndrome, analyze the causes of missed diagnosis and misdiagnosis, and propose corresponding preventive strategies.Methods:A retrospective analysis was made on the medical records and prenatal ultrasound images of 15 fetuses (including 14 cases referred from other hospitals) who underwent prenatal ultrasound examination in Guangdong Women and Children Hospital from August 2014 to May 2022 and were eventually clinically confirmed as Apert syndrome by induction or after birth. By conducting a comparative analysis, particularly focusing on the initial and final diagnoses of referral cases, the key ultrasound diagnostic points of Apert syndrome and the causes for missed and misdiagnosis were summarized.Results:①Diagnostic accuracy: Among the 15 fetuses, 11 cases (73.3%) were correctly diagnosed by prenatal ultrasound and 4 cases (26.7%) were missed diagnosis and misdiagnosis. For the 14 referral cases, only 2 cases (14.3%) were correctly identified in the initial diagnosis at the referring hospital (14.3%), and 12 cases (85.7%) were missed missed diagnosis and misdiagnosis. ②Detection rate of ultrasound signs: In the 15 fetuses with Apert syndrome, the detection rate of " cloverleaf" skull was 13.3% (2/15), premature coronal suture was 66.7% (10/15), the " brain shadowing sign" and flat occiput were both 93.3% (14/15), prominent forehead, hypertelorism and bilateral syndactyly of hands were all 100% (15/15), and bilateral syndactyly of feet was 73.3% (11/15). ③Analysis of missed diagnosis and misdiagnosis: Among the 4 cases of missed diagnosis and misdiagnosis in our hospital, premature closure of coronal suture, " brain shadowing sign", flat occiput and hypertelorism were all not recognized. Among these, 3 cases also missed the prominent forehead, bilateral syndactyly of hands and feet. Additionally, 1 case of bilateral syndactyly of hands was misdiagnosed as partial absence of metacarpals and phalangess.Conclusions:In the prenatal ultrasound diagnosis of fetal Apert syndrome, the symmetric syndactyly of both hands serves as an extremely important diagnostic clue. The " cloverleaf" skull is not common. The premature closure of coronal suture as a direct diagnostic sign with a high detection rate, highlighting its significance in the diagnostic of Apert syndrome. Furthermore, the high detection rates of characteristic ultrasound features such as prominent forehead, flat occiput, " brain shadowing sign" and hypertelorism could help to improve the accuracy of prenatal ultrasound diagnosis for Apert syndrome and effectively reduce missed and misdiagnosis.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

Humans ; Botulinum Toxins, Type A/therapeutic use* ; Esotropia/drug therapy* ; Neuromuscular Agents ; Injections ; Treatment Outcome ; Oculomotor Muscles

Objective:To explore the effect of scientific research group-based model on the improvement of nursing scientific research ability in a county-level hospital.Methods:A nursing research group was established, the composition of team members and work contents of the group were clarified, tiered focused scientific research training was implemented through progressive research content and flexible training methods, and individual and progressive research guidance was provided through research counseling application forms, while literature reading activities were conducted through article reports and literature debriefings. Retrospective analysis of the nursing research practice, the number of scientific research outputs, and research capacity were applied to evaluate the effect of the nursing research group-based model.Results:Within 2 years of the establishment of the nursing research group, 37 training programs were conducted, 33 scientific research materials were pushed to the WeChat public account, 23 scientific research projects were tutored, and 6 research projects were successfully declared. The scientific research ability score of nursing staff participating in literature reading debriefing increased from 44.24±19.12 to 53.57±13.86( P<0.001). Conclusions:The application of the nursing research group-based model can improve the nursing scientific research ability of the county-level hospital.