Atrial fibrillation(AF),a prevalent clinical tachyarrhythmia,has seen an increase in incidence with advancing age over recent decades.AF leads to severe complications,including stroke and heart failure,and is a sig-nificant cause of mortality.The pathogenesis of AF involves critical factors such as atrial electrical and structural remodeling,oxidative stress,and inflammatory responses.Recent studies highlight the pivotal role of macrophages in the initiation and progression of AF.This study focuses on the contributions of macrophages to the mechanisms of AF and summarizes cur-rent research findings.

Objective To investigate the clinical significance of combined cerebrospinal fluid(CSF)and routine blood parameter analysis in differentiating between multiple cerebral glioma(MCG)and primary central nervous system lymphoma(PCNSL).Methods We Rretrospectively analyzed the clinical data,CSF and routine blood indicators levels of 62 MCG patients and 56 PCNSL patients admitted to Beijing Tiantan Hospital,Capital Medical University from November 2017 to March 2023.Additionally,we assessed the diagnostic value of individual meaningful indicators as well as their combinations in distinguishing between MCG and PCNSL.Results The levels of CSF total cell count,CSF white cell count,CSF:pro,lactate,routine bloodperipheral neutrophil count,and neu-trophil percentage were significantly higher in the MCG group than in the PCNSL group(P<0.05);while the levels of CSF:Glu,CSF:cl,routine blood lymphocyte count,eosinophil,lymphocyte percentage,and eosinophil percent-age were significantly higher in the PCNSL group than in the MCG group(P<0.05).The AUCs of CSF cell count,CSF white cell count,CSF:pro,lactate,routine blood neutrophil count,neutrophil percentage for differentiating MCG from PCNSL were 0.900,0.899,0.797,0.867,0.828 and 0.772 respectively;sensitivities were 72.4%,77.6%,63.8%,67.2%,72.4%,82.8%,77.6%and 81%,with sensitivities of 97.1%,100%,88.2%,91.2%,88.2%,64.7%,100%and 94.1%,respectively.In addition,the combined detection of CSF total cell count,CSF white cell count,CSF:pro,routine blood neutrophil count and neutrophil percentage in CSF had an AUC of 0.919 for differentiating MCG from PCNSL,with a sensitivity and specificity of 77.6%and 100%,respectively.Conclusions Combined detection of CSF indicators including CSF total cell count,CSF white cell count,CSF:pro,along with routine blood markers such as neutrophil count and neutrophil percentage,holds significant clinical utility for differ-entiating between MCG and PCNSL.

Radiocarpal fracture-dislocation (RFD) is a rare injury normally associated with the destruction of bones, joints and ligaments. The improper diagnosis and treatment of RFD will cause severe complications and affect the long-term function of wrist joints. The difficulties of clinical diagnosis and treatment lie in the accurate diagnosis, identification and reconstruction of the structure of specific injury. As the foreign and domestic literatures are mainly case analyses or systemic case reports rather than large-scale reports, there still lacks a systemic knowledge of the standard diagnosis and treatment of RFD clinically, thus leading to problems such as missed diagnosed or misdiagnosed, improper application of treatment methods and incomplete reconstruction. Therefore, the authors reviewed relevant literatures about the features, diagnosis and treatment of RFD, in order to provide references for the clinical diagnosis and treatment of RFD.

OBJECTIVE To prepare hyperoside mixed nanomicelles （Hyp-F127/TPGS） and optimize its preparation technology，and to investigate its intestinal absorption characteristics. METHODS Hyp-F127/TPGS was prepared by thin film dispersion method. Based on single factor test and Plackett-Burman design ，combined with Box-Behnken response surface method ， the preparation process was optimized and validated using entrapped efficiency （EE）and drug loading （DL）as evaluation indexes ， F127-TPGS mass ratio ，hydration time and the amount of Hyp as factors. The appearance and microscopic morphology of Hyp-F127/TPGS obtained by the optimal technology were observed ，and the particle size ，polydispersity index （PDI）and Zeta potential were also determined. The critical micelle concentration （CMC）of blank micelle （F127/TPGS），in vitro release behavior and preliminary stability of Hyp-F 127/TPGS were investigated ，and absorption characteristics of Hyp-F 127/TPGS were investigated by in situ unidirectional intestinal perfusion model. RESULTS The optimal preparation technology of Hyp-F 127/TPGS included F127-TPGS mass ratio of 2∶1，hydration time of 2 h，and Hyp amount of 9 mg. Results of three validation tests showed that the EE of Hyp-F 127/TPGS was （87.20±0.99）％，and the DL was （5.02±1.20）％，deviations from predicted values were 0.92％ and 2.39％. The micelles prepared by optimal technology were yellow ，clear and transparent solution ，with good Tyndall effect ；under transmission electron microscope ，they were spherical ，complete and evenly distributed ；the particle size was （15.02±0.16）nm， the PDI was 0.092±0.031，and the Zeta potential was （－6.67±1.47）mV. The CMC of F 127/TPGS was 21 μg/mL，Hyp-F127/ TPGS was stable after 4 weeks of storage at 4 ℃，and the cumulative release rates of Hyp-F 127/TPGS and Hyp control were （66.30±2.93）％（96 h）and（99.24±0.27）％（60 h），respectively. Hyp-F 127/TPGS and Hyp reference were absorbed in each intestinal segment ，and the main absorption sites were jejunum and duodenum respectively ；drug absorption rate constant andapparent absorption coefficient of the former were significantly higher than those of the latter （P＜0.05 or P＜0.01）. E-mail：zhangyuhangxz@163.com CONCLUSIONS The optimized preparation technology of Hyp-F127/TPGS is stable and feasible ；prepared Hyp-F 127/ TPGS shows a sustained -release effect ，which promotes the intestinal absorption of H yp to a certain extent.

Objective:To summarize clinical characteristics of and treatment experience with patients with critical illnesses in a dermatological ward.Methods:All patients with serious or life-threatening conditions, who were hospitalized at the dermatological ward of the Second Xiangya Hospital of Central South University from July 9, 2011 to December 31, 2020, were collected, and their clinical data were retrospectively analyzed. Demographic characteristics, disease types and proportions, main complications, causes of serious or life-threatening conditions, important treatment measures and outcomes were summarized, and causes of death were also analyzed and discussed.Results:A total of 1 057 patients with critical illnesses were collected, with a male-to-female ratio of 1∶1.11, and 64.81% of them aged 18 to 65 years. The types of diseases mainly included drug eruptions (332 cases) , connective tissue diseases (226 cases) , bullous skin diseases (104 cases) , psoriasis (57 cases) , erythroderma (45 cases) , infectious skin diseases (67 cases) , etc. Among them, psoriasis (39 cases) and erythroderma (32 cases) mostly occurred in males, and connective tissue diseases (168 cases) mostly occurred in females. Common complications mainly involved infections, important organ damage or dysfunction, hypoalbuminemia, and fluid, electrolyte and acid-base imbalances. A total of 94 patients were diagnosed with life-threatening conditions, which were found to be mainly caused by primary skin diseases, hematologic abnormalities, respiratory failure, nervous system abnormalities, renal failure, sepsis, fluid, electrolyte and acid-base imbalances, etc. During the management of critical illnesses, 43 patients were treated with high-dose glucocorticoid pulse therapy, 264 were treated with gamma-globulin pulse therapy, 355 were transfused with other blood products, and 34 received special therapies such as hemoperfusion/immunoadsorption therapy, plasma exchange, dialysis, artificial liver support therapy; 42 patients were transferred to the intensive care unit (ICU) , 12 were transferred to the department of surgery for operations, and 12 were transferred to the department of obstetrics and gynecology for delivery or induction of labor. After treatment, 989 patients (93.57%) achieved improvement and were discharged. A total of 14 patients (1.32%) died, of whom 7 died of secondary sepsis, 2 died of severe pulmonary infections, 2 died of asphyxia caused by respiratory mucosa shedding-induced airway obstruction, the other 3 died of gastrointestinal hemorrhage, cerebral hemorrhage and neuropsychiatric systemic lupus erythematosus, respectively.Conclusions:Critical cases in the dermatological ward mainly suffered from serious skin diseases such as severe drug eruptions, connective tissue diseases and bullous skin diseases, as well as complications such as severe underlying diseases, severe organ dysfunction, sepsis or severe fluid, electrolyte and acid-base imbalances. In terms of treatment, it is of critical significance to make a clear diagnosis and assess the severity of disease as early as possible, monitor and prevent possible complications, and to consult with specialists in relevant disciplines in time.

Acute poisoning is a component of emergency medicine and a key public health problem in clinical toxicology. In recent years, the research and development of industrial chemicals and drugs have developed rapidly, and the incidence of acute drug poisoning has been increasing. It is very important to strengthen the application research of clinical toxicology in acute poisoning, to identify rare and new toxic drugs, and to create conditions for rapid detection of toxic substances. Therefore, this article reviews the types of acute poisoning, the epidemiological characteristics, the detection technology and significance of clinical toxicology, the role of clinical toxicology in the treatment of acute poisoning and its application.

Objective: To investigate the current situation of clinical nurses′ caring behavior and patients′ perception of caring, to understand the level of nursing care behavior and analyze the influencing factors, and to discuss the relationship between patients′ perception of caring and clinical nurses′ caring behavior. Methods: The convenience sampling method was used to investigate clinical nurses and inpatients from October to December 2018. The Caring Behavior Checklist was used to observe nurses' nursing care behavior, and the Client Perception of Caring Scale was used to investigate patients' perception of Caring. Results: A total of 132 clinical nurses were observed and 132 patients were investigated. The score of verbal caring behavior was (3.36±1.44) points (out of a possible 7 points), and the score of non-verbal caring behavior was (2.33±1.07) points (out of a possible 5 points).The overall score of Caring Behavior Checklist was (5.70±2.03) points (out of a possible 12 points). Nurses aged 26-35 (6.42±2.07) points had a higher level of nursing care behavior than nurses of other age groups, and the difference was statistically significant (F=3.902, P<0.05).N1 nurses had a higher level of nursing care behavior than nurses at other levels, it was (7.72±2.30) points, and the difference was significant (F=14.290, P<0.05). There was no significant difference in caring behavior level among nurses with different gender, departments, education backgrounds, academic titles and nursing ages (P>0.05). The overall score of Client Perception of Caring Scale was (43.49 ±3.84) (out of a possible 60 points), and there was a high positive correlation between client perception of caring and nursing care behavior (r=0.720, P<0.05). Conclusions The level of clinical nurses′ caring behavior is low, and the training of caring knowledge, belief and behavior should be carried out to promote nurses′ caring behavior, so as to further improve client perception of caring.

Objective To compare the clinical outcomes of mini-invasive plate osteosynthesis ( MIPO ) and conventional open plating for complex fractures of midshaft clavicle. Methods The authors retrospec-tively reviewed the data of complex fractures of midshaft clavicle ( AO/OTA types 15-B2 and 15-B3 ) which had been treated with MIPO or conventional open plating between January 2010 to February 2016. Forty-one patients were treated with MIPO and 43 with conventional open plating. The 2 groups were compared in terms of incision length, hospital stay, bone union time, postoperative Constant score and Disabilities of the Arm, Shoulder and Hand ( DASH ) score, patients'satisfaction and complications. Results The average follow-up was 21. 2 ± 9. 2 months for MIPO group and 23. 1 ± 11. 8 months for conventional open plating group. The incision length ( 4. 3 ± 0. 5 cm ) , hospital stay ( 7. 7 ± 1. 9 d ) and union time ( 10. 6 ± 3. 2 w ) in the MIPO group were signifi-cantly shorter than those in the conventional open plating group ( 8. 4 ± 1. 3 cm, 9. 6 ± 3. 1 d and 12. 3 ± 3. 9 w, respectively ) ( P <0. 05 ) . The MIPO group had significantly lower incidences of hypertrophic scarring and dysesthesia in the area of incision but significantly higher patients'satisfaction than the conventional open plating group ( P <0. 05 ) . There were no significant differences in the Constant score or DASH score at 3 months, 6 months and the final follow-up ( P > 0. 05 ) . Conclusion In the treatment of complex fractures of midshaft clavicle, although both MIPO and conventional open plating can lead to similar functional outcomes, MIPO may be advantageous over conventional open plating in smaller surgical incision, more rapid fracture union, shorter hospital stay and higher patients'satisfaction.

Objective To evaluate the clinical outcomes of split fractures of humeral greater tuberosity treated by our self-designed new type of anatomical locking plate.Methods From September 2012 to February 2017,23 patients were treated for acute split fracture of the humeral greater tuberosity using our self-designed new type of anatomical locking plate.They were 13 males and 10 females with a mean age of 52.8 years (range,from 25 to 81 years).Of them,6 were beyond 60 years old, 12 had comminuted fracture,10 were complicated with glenohumeral dislocation,and 12 with rotator cuff tear.The patients were evaluated clinically with Constant-Murley score,visual analog scale (VAS),range of motion and complications at the last follow-ups.Results This series were followed up for 12 to 30 months (mean,23.2 months).All the fractures healed after an average time of 10.6 weeks (range,from 8 to 12 weeks).Their mean Constant-Murley Score was 92.1 points (range,from 70 to 100 points),giving an excellent and good rate of 95.7％ (22/23);their VAS scores averaged 0.8 points (range,from 0 to 4 points).Their forward flexion averaged 160.6°,abduction 157.8°,external rotation 46.4°,and internal rotation up to the T11 level,respectively.Their complications rate was 17.4％ (4/23).One case of axillary nerve injury,one case of relapse of glenohumeral dislocation at sports,and 2 cases of stiff shoulder were observed.Conclusion Split fractures of the humeral greater tuberosity can be successfully treated with our new type of anatomical locking plate which serves as a new alternative treatment.

Objective To study the existence and significance of cholesterol-intestinal hepatic circulation in rabbits by establishing a model of enterohepatic circulation and blocking enterohepatic circulation. Methods In this experiment, the experimental group and the control group were set up to conduct high-cholesterol diets and ordinary diets for differential feeding. By establishing a model of enterohepatic circulation and blocking enterohepatic circulation, cholesterol oxidase method was used to measure serum cholesterol concentration in the experimental group and the control group respectively. Based on the statistical analysis of the data for 6 months, the phenomenon of enterohepatic circulation of cholesterol was studied. Results Based on the data of 6 months, the serum cholesterol concentrations of rabbits in groups Aand Cwere gradually increased. After two months, the hypercholesterolemia was significant in the rabbits in group C. The increase degree of serum cholesterol concentration in the rabbits in group Awas weaker than that in group C. Hypercholesterolemia had no obvious effect. There was statistically significant difference between group Aand group C (P＜0. 05); serum cholesterol concentration in rabbits in group Dwas increased slightly, but the increase was not significant. The increase of serum cholesterol concentration in group Bwas more significant than that of group D. There was a statistically significant difference between group Band group D (P＜0. 05). The serum TC-time line graph was plotted with the serum cholesterol concentration in each group as the ordinate and the time as the abscissa. Compared with group A, the serum cholesterol was increased significantly in group C. Compared with group D, the serum cholesterol in group Bwas increased significantly. Conclusion This experiment shows that the cholesterol enterohepatic circulation phenomenon exists in rabbits. By blocking the enterohepatic circulation in rabbits, it has a certain effect on lowering the content of serum cholesterol in rabbits. This will provide a theoretical basis for further studying the role of blocking enterohepatic circulation in reducing cholesterol levels in the body. It provides new ideas for the clinical treatment of hypercholesterolemia by blocking the cholesterol enterohepatic circulation in clinical practice and points a direction for drug development.