Objective To evaluate efficacy and safety of 5 different Chinese herbal decoctions in the treatment of rheumatoid arthritis(RA)by network Meta-analysis.Methods PubMed,Embase,Cochrane Library and Web of Science,CNKI,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs)of 5 kinds of traditional Chinese medicine decoctions(Juanbi decoction,Wutou decoction,Baihu plus Guizhi decoction,Guizhi Shaoyao Zhimu decoction and Duhuo Jisheng decoction)combined with conventional treatment such as methotrexate and meloxicam from inception to January 1,2024.Two reviewers independently screened literature,extracted data and assessed risk bias of included studies.The network Meta-analysis was then performed using Stata 17 software.Results A total of 35 RCTs involving 3 316 patients were included.The results of the network Meta-analysis found that compared with conventional treatment,5 kinds of traditional Chinese medicine decoction+conventional treatment significantly increased total clinical effective rate(P＜0.05);Juanbi decoction+conventional treatment,Guizhi Shaoyao Zhimu decoction+conventional treatment,Duhuo Jisheng decoction+conventional treatment significantly reduced RF level(P＜0.05);Juanbi decoction+conventional treatment,Wutou decoction+conventional treatment,Guizhi Shaoyao Zhimu decoction+conventional treatment,Duhuo Jisheng decoction+conventional treatment significantly reduced CRP level and ESR level(P＜0.05);Guizhi Shaoyao Zhimu decoction+conventional treatment,Duhuo Jisheng decoction+conventional treatment significantly reduced incidence of adverse reactions(P＜0.05).The cumulative probability ranking results showed that Guizhi Shaoyao Zhimu decoction+conventional treatment had the best effect in improving the total clinical effective rate and reducing RF level and incidence of adverse reactions;Wutou decoction+conventional treatment had the best effect in reducing CRP level;Juanbi decoction+conventional treatment had the best effect in reducing ESR level.Conclusion Traditional Chinese medicine decoction combined with conventional treatment can improve the overall efficacy of RA.In terms of improving indexes,Guizhi Shaoyao Zhimu Decoction or Juanbi decoction combined with conventional treatment can be selected for clinical treatment of RA.Guizhi Shaoyao Zhimu decoction or Duhuo Jisheng decoction combined with conventional therapy can be selected to improve safety.Due to the limited quantity and quality of the included studies,more high-quality studies are needed to verify the above conclusion.

Objective:To analyze the distribution characteristics of plasma renin concentration (PRC) in patients with aldosterone-producing adenoma (APA) and its impact on diagnosis.Methods:In this retrospective case series, clinical data from 200 patients with APA (80 men and 120 women; mean age 45.6 years) in the First Affiliated Hospital of Chongqing Medical University from November 2013 to January 2022 were evaluated. PRC was determined by automated chemiluminescence immunoassay. The distribution characteristics of PRC were analyzed, and 8.2 mU/L was used as the low renin cutoff to evaluate whether renin was suppressed.Results:The median PRC was 1.6 mU/L (range, 0.4-41.5 mU/L). There were 116 patients with APA with PRC of ≤2 mU/L, 41 patients with 28.2 mU/L) in 8.0% (16/200) of the patients with APA. And PRC was not suppressed in 2.5% (5/200) of the patients with APA, resulting in a primary aldosteronism negative screening outcome.Conclusions:Although most patients with APA have low PRC, there are a small number (8%) of patients whose PRC has not been fully suppressed, which can lead to missed diagnoses during primary aldosteronism screening. While primary aldosteronism is highly suspected, further investigations are required to determine the diagnosis, even if PRC is not fully suppressed at screening.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Focal cortical dysplasia (FCD) is one of the most common causes of drug-resistant epilepsy. Dysmorphic neurons are the major histopathological feature of type II FCD, but their role in seizure genesis in FCD is unclear. Here we performed whole-cell patch-clamp recording and morphological reconstruction of cortical principal neurons in postsurgical brain tissue from drug-resistant epilepsy patients. Quantitative analyses revealed distinct morphological and electrophysiological characteristics of the upper layer dysmorphic neurons in type II FCD, including an enlarged soma, aberrant dendritic arbors, increased current injection for rheobase action potential firing, and reduced action potential firing frequency. Intriguingly, the upper layer dysmorphic neurons received decreased glutamatergic and increased GABAergic synaptic inputs that were coupled with upregulation of the Na⁺-K⁺-Cl^- cotransporter. In addition, we found a depolarizing shift of the GABA reversal potential in the CamKII-cre::PTEN^flox/flox mouse model of drug-resistant epilepsy, suggesting that enhanced GABAergic inputs might depolarize dysmorphic neurons. Thus, imbalance of synaptic excitation and inhibition of dysmorphic neurons may contribute to seizure genesis in type II FCD.
Animals ; Drug Resistant Epilepsy/surgery* ; Epilepsy/pathology* ; Malformations of Cortical Development/pathology* ; Malformations of Cortical Development, Group I ; Mice ; Neurons/pathology* ; Seizures/pathology*

Brain ; pathology ; China ; Humans ; Organ Preservation ; standards ; Tissue Banks ; ethics ; standards

The laterodorsal tegmentum (LDT) is a brain structure involved in distinct behaviors including arousal, reward, and innate fear. How environmental stimuli and top-down control from high-order sensory and limbic cortical areas converge and coordinate in this region to modulate diverse behavioral outputs remains unclear. Using a modified rabies virus, we applied monosynaptic retrograde tracing to the whole brain to examine the LDT cell type specific upstream nuclei. The LDT received very strong midbrain and hindbrain afferents and moderate cortical and hypothalamic innervation but weak connections to the thalamus. The main projection neurons from cortical areas were restricted to the limbic lobe, including the ventral orbital cortex (VO), prelimbic, and cingulate cortices. Although different cell populations received qualitatively similar inputs, primarily via afferents from the periaqueductal gray area, superior colliculus, and the LDT itself, parvalbumin-positive (PV) GABAergic cells received preferential projections from local LDT neurons. With regard to the different subtypes of GABAergic cells, a considerable number of nuclei, including those of the ventral tegmental area, central amygdaloid nucleus, and VO, made significantly greater inputs to somatostatin-positive cells than to PV cells. Diverse inputs to the LDT on a system-wide level were revealed.

Objective Secondary infection with pseudomonas aeruginosa( PA) in diabetic foot ulcer( DFU) was analyzed to investigate the related risk factor, antibiotic resistance, and prognoses of the infection. Methods Pathogen cultures were carried out in 966 DFU patients with their clinical data collected. All of the patients were followed-up for two years to observe the outcomes, including ulcer healing, amputation, recurrence of ulcers, non-fatal cardiovascular events, and death. The antibiotic susceptibility, risk factors and associated outcome of secondary PA infection were analyzed. Results Total incidence of PA infection was 13. 0％ in DFU patients, of which 38. 1％was secondary. The susceptibility rates of secondary infected PA to tobramycin, meropenem, eftazidime, levofloxacin, cefepime, and cefepime were similar to those in primary infected PA. However, the susceptibility rates of secondary infected PA to piperacillin, piperacillin/tazobactam, ciprofloxacin, imipenen, gentamicin, aztreonam, and amikacin decreased by 12％ to 22％ as compared with primary infected PA. The healing rate was much lower in patients with secondary PA infection compared with those with primary PA infection, and the accumulated healing rates at2yearswere44.44％ and70.4％ (P=0.01) respectively. Theriskofulcerhealingfailurewithintwoyears increased by 3 folds in patients with secondary PA infection. After adjusting for age, sex, Wagner grade, infection grade, and duration of DFU, plasma albumin level was an independent risk factor for secondary PA infection in patients with DFU(P=0. 001). Conclusions The antibiotics susceptibility rates of secondary infected PA were lower than those of primary infected PA. Secondary PA infection in DFU was less likely to be healed. Plasma albumin level was a risk factor for secondary PA infection.

Objective To investigate the association of serum C peptide concentration with the severity and the outcome of diabetic foot ulcer (DFU). Methods The clinical data of 257 inpatients with DFU were collected, including fasting and postprandial 2h C peptide levels and C peptide area under curve (AUCCP ). The patients were followed up on the outcomes of ulcers and death. The associations of serum C peptide concentration with the Wagner degree, infection severity, and healing rate were analyzed. Results The medians of fasting and 2h postprandial serum C peptide as well as AUCCP were 1. 37(0. 02 ~ 9. 00) nmol/ L, 3. 22(0. 02 ~ 29. 61) nmol/ L, and 511. 65 (3. 60 ~ 2 691. 30)nmol·min-1 ·L-1 respectively, which were lower than general levels. The time of follow-up in our study was 2. 8 (1. 0 ~ 5. 1) years. By the end of study, the wound of 75. 88% patients was healed, 3. 5%undergone major amputation, and 23. 74% died. After adjusting for relative factors, there were no significant associations of serum fasting and postprandial C peptide levels and AUCCP with Wagner degree and infection severity (P>0. 05). Cox regression analysis showed that the fasting plasma C peptide and hemoglobin were the independent protective factors for the healing of ulcers; old age, male, higher infection degree, and diabetes family history were their independent risk factors ( all P < 0. 05). Conclusions The lower plasma fasting C peptide concentration in patients with DFU is not correlated with Wagner degree and infection severity, but closely related with healing rate.

Objective To evaluate the anesthetic effect and safety of ropivacaine combined with lidocaine caudal block in the treatment of pediatric laparoscopic hernia surgery.Methods A total of 70 cases with pediatric hernia surgery in Ningbo Women and Children’s Hospital from May 2014 to October 2015 in this study were divided into control group and experimental group with 35 cases in each group.The patients in the both groups were given routine examination, preoperative anesthesia induction, adopted 7 scalp injection needles to prick into the hiatus sacralis,patients in control group were treated by 1% lidocaine hydrochloride injection mixed liquid 1 mL/kg;patients in the experimental group were treated by 0.25%lidocaine hydrochloride injection and 0.25% ropivacaine hydrochloric injection mixed liquid 1 mL/kg; pediatric hernia surgery, intraoperative continuous pumped into propofol injection 4-6 mL/kg and maintain the mask to the oxygen.The visual analog pain scored( VAS) , visual satisfaction scored ( VSS) and adverse reactions were compared at the end of operation, after operation 0 h,0.5 h,1 h,2 h,4 h,8 h and 24 h.Results The sensory and motor block effective time in the experimental group were later than the control group, the sensory and motor block duration time were shorter than the control group (P<0.05).VAS score of the experimental group was significant lower than control group after operation 2 h ( P<0.05 ) . After operation, postoperative 0.5 h, postoperative 1 h, the VSS score of the experimental group was significant lower than control group ( P<0.05 ) .Lower limbs numbness discomfort duration time of the experimental group was significant lower than control group after operation ( P<0.05 ) . Postoperative agitation rate of the experimental group 8.57% was significant lower than the control group 34.29% (P<0.05).The incidence of adverse reactions of experimental group 5.71% was significant lower than the control group 25.71% ( P<0.05 ) .Conclusion Ropivacaine combined with lidocaine caudal block in the treatment of pediatric hernia surgery has the remarkable effect, with high safety.

Objective To investigate effect of different doses of propofol infusion on serum lipid metabolism and pulmonary function in patients with cervical cancer operation.Methods 120 patients with cervical cancer were randomly divided into A, B, C three groups, 40 cases in each group, were treated with laparoscopic cervical cancer radical operation, the 4 mg/(kg· h), 6 mg/(kg· h), 8 mg/(kg· h), and the pulmonary function and lipid profiles were detected.Results Compared with the B and C groups, the recovery time and the the awake time of the patients in B ,C group was shorter (P<0.05).The recovery time and the the awake time of the patients in A group had not significantly different.Compared with before operation, TG, TC and LDL levels were elevated, HDL decreased in theree groups after the operation(P<0.05);compared with the A and B groups, the levels of TC, LDL, TG and were higher, the level of HDL were lower (P<0.05),there were no significant differences in level of TC, HDL, TG and LDL between group A and group B;there was no significant difference between P(A-a) O2 and RI among three groups before surgery, P(A-a) O2 and RI levels were elevated in the three groups after surgery(P<0.05), compared with the A and B groups, P(A-a)O2 and RI levels in group C were lower(P<0.05), there was no significant difference in P(A-a)O2 and RI between group A and group B.Conclusion 4 mg/(kg· h)of propofol can significantly shorten the recovery time and awake time, improve the level of lipid metabolism and pulmonary function.