ObjectiveTo evaluate the clinical efficacy and safety of Tongluo Mingmu capsules in the treatment of diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome. MethodA randomized， double-blind， positive-control， and multi-center clinical trial design method was used. 416 patients with diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome in four test centers were included （the ratio of the treatment group to the control group was 3∶1）. On the basis of standardized hypoglycemic treatment， the treatment group was given both four Tongluo Mingmu capsules and two Calcium Dobesilate capsule agents three times a day， while the control group were given both two Calcium Dobesilate capsules and four Tongluo Mingmu capsule agents three times a day. The course of treatment was 12 weeks. The curative effect of Tongluo Mingmu capsules was evaluated by comparing the comprehensive curative effect of diabetic retinopathy， traditional Chinese medicine（TCM） syndrome score， corrected visual acuity， fundus changes， fundus fluorescence angiography， and other curative effect indexes before and after treatment in the two groups. At the same time， general examination， laboratory examination， and adverse events were performed to evaluate the safety of the drug. ResultThe baseline demographic data and disease characteristics of the treatment group and the control group were balanced and comparable， with the difference not statistically significant. After 12 weeks of treatment， the total effective rate of the comprehensive curative effect of diabetic retinopathy in the treatment group （61.0%， 189/310） was better than that in the control group （44.1%， 45/102）， and the difference was statistically significant （χ²=8.880， P<0.01）. The total effective rate of TCM syndromes in the treatment group （88.4%， 259/293） was better than that in the control group （69.9%， 65/93）， and the difference was statistically significant （χ²=17.927， P<0.01）. The disappearance rate of dry eyes （χ²=8.305）， dull complexion （χ²=4.053）， lassitude （χ²=10.267）， shortness of breath （χ²=8.494）， and dry stool （χ²=8.657） in the treatment group was higher than that in the control group， and the difference between the groups was statistically significant （P<0.05， P<0.01）. In terms of improving corrected visual acuity （χ²=8.382）， fundus changes （χ²=6.026） ， the treatment group was significantly better than the control group （P<0.05）. During the trial， the incidence of adverse events in the treatment group and the control group was 1.3% and 2.9%， respectively. There was no significant difference between the two groups. In addition， there were no serious adverse events and adverse events leading to withdrawal in both groups. ConclusionTongluo Mingmu capsules can improve the comprehensive curative effect of diabetic retinopathy and enhance the efficacy of TCM syndromes， visual acuity， fundus changes， and fundus fluorescein angiography， with great safety. Therefore， it can provide a new alternative therapeutic drug for patients with diabetic retinopathy.

BACKGROUND:Glucocorticoid-induced osteoporosis is a common complication of systemic glucocorticoid therapy,which is mainly characterized by its inhibitory effect on osteoblasts.Eriodictyol inhibits osteoclast differentiation and osteoporosis-induced by ovariectomy.However,it is unclear whether eriodictyol regulates glucocorticoid-induced osteoblasts. OBJECTIVE:To explore whether eriodictyol plays a role in glucocorticoid-induced osteoblast apoptosis and its potential regulatory mechanisms. METHODS:Dexamethasone-pretreated osteoblasts MC3T3-E1 were treated with the different concentrations(0,0.5,1,2.5,5,10 μmol/L)of eriodictyol or 5 μmol/L 3-methyladenine,an autophagy inhibitor,and then transfected with heme oxygenase 1 overexpression vector(pcDNA-HMOX1)and empty vector(pcDNA vector).Cell proliferation and apoptosis were assessed by using cell counting kit-8 assay and flow cytometry,respectively.The activity of caspase-3 was detected with ELISA.Western blot assay was used to detect the protein expression of autophagy-related proteins LC3-Ⅱ/LC3-Ⅰ,p62,Atg5 and Atg12,the expression of apoptotic related proteins Bax and Bcl-2,as well as the protein expression of AMPK and p-AMPK. RESULTS AND CONCLUSION:Low concentrations of eriodictyol were non-toxic to MC3T3-E1 cells and promoted cell proliferation,as well as increased the expression of autophagy related proteins LC3-Ⅱ/LC3-Ⅰ,p62,Atg5 and Atg12,decreased caspase-3 enzyme activity,inhibited Bax protein expression,promoted Bcl-2 protein expression and reduced dexamethasone-induced apoptosis in MC3T3-E1 cells in a dose-dependent manner.Moreover,eriodictyol significantly promoted heme oxygenase 1 expression in osteoblasts,whereas overexpression of heme oxygenase 1 promoted AMPK phosphorylation,activated autophagy,and inhibited dexamethasone-induced osteoblast apoptosis.While 3-methyladenine treatment counteracted the effects of heme oxygenase 1 overexpression on MC3T3-E1 cells.To conclude,low concentration of Eriodictyol is non-toxic to osteoblasts and activates AMPK signaling pathway by upregulating the expression of heme oxygenase 1,thereby promoting autophagy and inhibiting dexamethasone-induced osteoblast apoptosis.Eriodictyol has great potential for the treatment of glucocorticoid-induced osteoporosis.

Objective:To evaluate the relationship between pelvimetric parameters and surgical difficulty in robot-assisted total mesorectal excision (TME) performed by experienced colorectal surgeons, and to build a nomogram model.Methods:This was a retrospective observational study. The inclusion criteria were as follows: (1) tumor within 10 cm of the anal verge; (2) cancer confirmed by pathological examination of the postoperative specimen; (3) preoperative complete magnetic resonance imaging (MRI) data available; (4) depth of tumor invasion T1-3; (5) circumferential resection margin assessed as negative by MRI; and (6) R0 resection achieved. The exclusion criteria comprised (1) history of pelvic fractures; (2) history of pelvic surgery; and (3) emergency required because of tumor-related intestinal obstruction and/or perforation. Application of above criteria yielded 82 patients who had undergone robot-assisted total mesorectal excision of mid and low rectal cancer in the Department of Colorectal Surgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 (modeling group). Additionally, data of 35 patients with mid and low rectal cancer who had undergone robotic-assisted TME at the same center in 2023 January–August were collected for validation of the model (validation group). The following 13 pelvic parameters were studied: pelvic inlet diameter, pelvic outlet diameter, pubic tubercle height, sacral height, sacral depth, interspinous distance, inter-tuberosity distance, lateral mesorectal span, anterior-posterior mesorectal span, anterior mesorectal thickness, posterior mesorectal thickness, rectal area, and mesorectal area. Operating time was used as an indicator of the degree of surgical difficulty, this being defined as the time from the start of skin incision to the end of abdominal closure. Variables related to the duration of surgery were subjected to univariate and multivariate logistic regression analyses to identify factors associated with the difficulty of TME, after which a nomogram for predicting the difficulty of the procedure was established. We constructed receiver operating characteristic and calibration curves to validate the predictive power of nomogram. Furthermore, data from the validation group were used for external validation of the model.Results:The model group comprised 82 patients, including 54 men and 28 women of median age 61.0 years. The median body mass index (BMI) was 23.7 kg/m 2, median distance between the tumor and anal verge 6.1 cm, and median tumor diameter 4.5 cm. Fourteen of these patients had received preoperative adjuvant therapy and 12 had a history of abdominal surgery. There were 35 patients (24 men and 11 women) of median age 64.0 years in the validation group. Their median BMI was 23.7 kg/m 2 and median distance between the tumor and anal verge 6.3 cm. Multivariable analyses of the model group showed that BMI (OR=1.227, 95%CI: 1.240–1.469, P=0.026), distance between the tumor and anal verge (OR=0.733, 95%CI: 0.562–0.955, P=0.022), and interspinous distance (OR=0.468, 95%CI: 0.270–0.812, P=0.007) were independent predictors of surgical difficulty. We then built and validated a predictive nomogram based on the above three variables (AUC=0.804, 95%CI: 0.707–0.900). Calibration curves showed that the S:P in this model was 0.987 and the C-index 0.804. Area under the receiver operating characteristic curve of the predictive model in the validation dataset was 0.767 (95%CI: 0.606–0.928). Conclusion:MRI-based measurements of pelvic parameters are associated with difficulty of performing robot-assisted TME for mid and low rectal cancer. Our nomogram model constructed based on measurements of pelvic parameters has a good predictive ability.

Objective:To explore the long-term effects of intravascular ultrasound (IVUS) guidance on patients with acute coronary syndrome (ACS) undergoing drug-eluting stents (DES) implantation.Methods:Data used in this study derived from ULTIMATE trial, which was a prospective, multicenter, randomized study. A total of 1 448 all-comer patients were enrolled between 2014 August and 2017 May. Primary endpoint of this study was target vessel failure (TVF) at 3 years, including cardiac death, target-vessel-related myocardial infarction, and clinically-driven target vessel revascularization.Results:ACS was present in 1 136 (78.5%) patients, and 3-year clinical follow-up was available in 1 423 patients (98.3%). TVF in the ACS group was 9.6% (109/1 136), which was significantly higher than 4.5% (14/312) in the non-ACS group (log-rank P=0.005). There were 109 TVFs in the ACS patients, with 7.6% (43/569) TVFs in the IVUS group and 11.6% (66/567) TVFs in the angiography group (log-rank P=0.019). Moreover, patients with optimal IVUS guidance were associated with a lower risk of 3-year TVF compared to those with suboptimal IVUS results (5.4% (16/296) vs. 9.9% (27/273),log-rank P=0.041). Conclusions:This ULTIMATE-ACS subgroup analysis showed that ACS patients undergoing DES implantation were associated with a higher risk of 3-year TVF. More importantly, the risk of TVF could be significantly decreased through IVUS guidance in patients with ACS, especially in those who had an IVUS-defined optimal procedure.

The onset of myasthenia gravis (MG) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) seriously threatens the survival of patients, since it is acute, and is prone to rapid progression. Two patients with acute myeloid leukemia (AML), who had undergone allo-HSCT developed shortness of breath, and gradually developed cervical weakness and dyspnea. The acetylcholine receptor (AChR) antibody and neostigmine test enabled the diagnosis of MG. The condition of the patients improved after treatment with pyridostigmine bromide, glucocorticoids and rituximab.

Myositis antibodies are divided into myositis-specific autoantibodies(MSA)and myositis-associated autoantibodies(MAA).There are heterogeneity in the mechanism,clinical features and prognosis of interstitial lung disease(ILD)in the different myositis antibodies.In MSA,anti-melanoma differentiation-related gene 5(MDA5)antibody and anti-aminoacyl synthetase(ARS)antibody are highly correlated with the occurrence of ILD.Patients with MDA5+DM-ILD usually have a rapidly progressive and poor prognosis.The progress of ILD in ARS+DM patients was slow,and the response to treatment is good,but it is easy to relapse.In MAA,anti-Ro52 antibodies often coexist with MSA antibodies,and clinical manifestation is closely related to coexisting antibodies.This review has summarized roles of myositis antibodies in ILD.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective:To evaluate the relationship between pelvimetric parameters and surgical difficulty in robot-assisted total mesorectal excision (TME) performed by experienced colorectal surgeons, and to build a nomogram model.Methods:This was a retrospective observational study. The inclusion criteria were as follows: (1) tumor within 10 cm of the anal verge; (2) cancer confirmed by pathological examination of the postoperative specimen; (3) preoperative complete magnetic resonance imaging (MRI) data available; (4) depth of tumor invasion T1-3; (5) circumferential resection margin assessed as negative by MRI; and (6) R0 resection achieved. The exclusion criteria comprised (1) history of pelvic fractures; (2) history of pelvic surgery; and (3) emergency required because of tumor-related intestinal obstruction and/or perforation. Application of above criteria yielded 82 patients who had undergone robot-assisted total mesorectal excision of mid and low rectal cancer in the Department of Colorectal Surgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 (modeling group). Additionally, data of 35 patients with mid and low rectal cancer who had undergone robotic-assisted TME at the same center in 2023 January–August were collected for validation of the model (validation group). The following 13 pelvic parameters were studied: pelvic inlet diameter, pelvic outlet diameter, pubic tubercle height, sacral height, sacral depth, interspinous distance, inter-tuberosity distance, lateral mesorectal span, anterior-posterior mesorectal span, anterior mesorectal thickness, posterior mesorectal thickness, rectal area, and mesorectal area. Operating time was used as an indicator of the degree of surgical difficulty, this being defined as the time from the start of skin incision to the end of abdominal closure. Variables related to the duration of surgery were subjected to univariate and multivariate logistic regression analyses to identify factors associated with the difficulty of TME, after which a nomogram for predicting the difficulty of the procedure was established. We constructed receiver operating characteristic and calibration curves to validate the predictive power of nomogram. Furthermore, data from the validation group were used for external validation of the model.Results:The model group comprised 82 patients, including 54 men and 28 women of median age 61.0 years. The median body mass index (BMI) was 23.7 kg/m 2, median distance between the tumor and anal verge 6.1 cm, and median tumor diameter 4.5 cm. Fourteen of these patients had received preoperative adjuvant therapy and 12 had a history of abdominal surgery. There were 35 patients (24 men and 11 women) of median age 64.0 years in the validation group. Their median BMI was 23.7 kg/m 2 and median distance between the tumor and anal verge 6.3 cm. Multivariable analyses of the model group showed that BMI (OR=1.227, 95%CI: 1.240–1.469, P=0.026), distance between the tumor and anal verge (OR=0.733, 95%CI: 0.562–0.955, P=0.022), and interspinous distance (OR=0.468, 95%CI: 0.270–0.812, P=0.007) were independent predictors of surgical difficulty. We then built and validated a predictive nomogram based on the above three variables (AUC=0.804, 95%CI: 0.707–0.900). Calibration curves showed that the S:P in this model was 0.987 and the C-index 0.804. Area under the receiver operating characteristic curve of the predictive model in the validation dataset was 0.767 (95%CI: 0.606–0.928). Conclusion:MRI-based measurements of pelvic parameters are associated with difficulty of performing robot-assisted TME for mid and low rectal cancer. Our nomogram model constructed based on measurements of pelvic parameters has a good predictive ability.

Objective To investigate the effect of radiation on cardiomyocyte apoptosis and its related mechanism.Methods Rat H9C2 cardiomyocytes were divided into blank control group,X-ray irradiation group(X-ray group),X-ray irradiation+microRNA(miRNA)-134-5p inhibitor group(X-inhibitor group)and X-ray irradiation+miRNA-134-5p inhibitor negative control group(X-NC group).H9C2 cardiomyocytes were irradiated with 6 Gy X-ray,and the changes of various indexes were detected 48 h after irradiation.Cell viability was detected by cell counting kit 8 assay.The apoptosis rate was detected by flow cytometry and Hoechst 33342 staining.The level of reactive oxygen species(ROS)in cells was detected by DCFH-DA fluorescence probe.The mitochondrial membrane potential was detected by JC-1 method.The activity of superoxide dismutase(SOD)and the level of malondialdehyde(MDA)in cells were measured by kits.The expression of miRNA-134-5p was detected by quantitative polymerase chain reaction.The protein expression of brain-derived neurotrophic factor(BDNF),protein kinase B(Akt),phosphorylated Akt(p-Akt),Bcl2 and Bax was detected by Western blotting.Results Compared with the blank control group,in the X-ray group the levels of ROS and MDA were significantly increased,the activity of SOD was significantly decreased,the decreased percentage in mitochondrial membrane potential was significantly increased,the number of micronuclei of DNA damage was significantly increased,and the apoptosis rate was significantly increased(all P＜0.01).Compared with the X-ray group,all the indexes of the X-inhibitor group were reversed(P＜0.05 or P＜0.01),while there was no significant difference in the above parameters in the X-NC group(all P＞0.05).Compared with the blank control group,the X-ray group had a significant increase in the miRNA-134-5p level and significant reductions in the protein level of BDNF,Bcl2/Bax ratio,and p-Akt/Akt ratio(all P＜0.01).Compared with the X-ray group,the X-inhibitor group had a significant reduction in the level of miRNA-134-5p and significant increases in the protein level of BDNF,Bcl2/Bax ratio,and p-Akt/Akt ratio(all P＜0.01),and there was no significant difference in all parameters in the X-NC group(all P＞0.05).Conclusion X-ray irradiation can induce oxidative stress,mitochondrial damage,and DNA damage,eventually leading to apoptosis in rat cardiomyocytes,and the mechanism may involve miRNA-134-5p/BDNF/Akt signaling pathway.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.