Acute pancreatitis （AP） is one of the most clinically common acute digestive disorders characterized by quick onset，rapid progression，severe condition，and high mortality. If the disease is not timely intervened in the early stage，it can develop into severe AP in the later stage，which damages the long-term quality of life and brings serious economic burden to patients and their families. However， the pathogenesis of this disease is complex and has not been fully explained. The generation and development of AP is closely related to many signaling pathways. Among them，Toll-like receptor 4（TLR4），as a transmembrane signal transduction receptor，can mediate immune response and inflammatory response，and play a key role in the occurrence and development of AP. Traditional Chinese medicine（TCM）can regulate the TLR4 signaling pathway with multiple targets，multiple effects，and multiple administration methods to inhibit inflammatory response，and effectively intervene in the progression of AP， which has gradually become a new craze for preventing and treating AP. Many studies have shown that TCM has obvious advantages in the prevention and treatment of AP. It can effectively treat AP by regulating TLR4 signaling pathway，strengthening immune resistance and defense，and inhibiting inflammatory response. Despite of the research progress，there is still a lack of comprehensive review on TCM regulation of TLR4 signaling pathway in the treatment of AP. Therefore，the literature on TCM regulation of TLR4 signaling pathway published in recent years was systematically reviewed and elaborated，aiming to provide new ideas for the treatment of AP and further drug development.

Objective:To analyze the clinical value of dynamic electrocardiogram combined with serum brain natriuretic peptide (BNP) and creatine kinase isoenzyme (CK-MB) levels in evaluating the severity of respiratory tract infection complicated with viral myocarditis.Methods:A total of 125 patients with respiratory tract infection who were admitted to the Affiliated Run Run Shaw Hospital of Medical School, Zhejiang University from January 2018 to December 2022 were selected retrospectively. They were divided into the complication group (71 cases) and the non-complication group (54 cases) according to whether they were complicated with viral myocarditis. Dynamic and conventional electrocardiogram characteristics were compared. Serum BNP and CK-MB levels in the complication group and the non-complication group at admission were analyzed. Dynamic electrocardiograms and serum BNP and CK-MB levels of patients with different severity of myocarditis were comparatively analyzed. The value of combined diagnosis was analyzed.Results:The detection rates of atrial premature beats and sinus tachycardia by dynamic electrocardiogram were higher than those by conventional electrocardiogram: 38.03% (27/71) vs. 22.54% (16/71), 28.17% (20/71) vs. 14.08% (10/71) ( P<0.05). Serum BNP and CK-MB levels in the complication group were higher than those in the non-complication group: (104.26 ± 10.75) ng/L vs. (54.11 ± 5.69) ng/L, (17.89 ± 1.86) U/L vs. (13.46 ± 1.42) U/L ( P<0.05). The detection rates of atrial premature beats, sinus tachycardia, burst ventricular tachycardia, first-degree atrioventricular block, ST segment change and low QRS voltage, serum BNP and CK-MB levels in patients with respiratory tract infection complicated with severe viral myocarditis (37 cases) were higher than those in patients with mild viral myocarditis (34 cases): 51.35% (19/37) vs. 23.53% (8/34), 43.24% (16/37) vs. 11.76% (4/34), 32.43% (12/37) vs. 11.76% (4/34), 29.73% (11/37) vs. 8.82% (3/34), 43.24% (16/37) vs. 14.71% (5/34), 24.32% (9/37) vs. 5.88% (2/34), (107.19 ± 10.56) ng/L vs. (101.08 ± 10.18) ng/L, (18.33 ± 1.85) U/L vs. (17.41 ± 1.76) U/L ( P<0.05). Compared with clinical pathological diagnosis, Kappa values of dynamic electrocardiogram, BNP at admission, CK-MB at admission and combination of the three for diagnosing acute upper respiratory tract infection complicated with viral myocarditis were 0.784, 0.765, 0.733 and 0.879. The sensitivity and accuracy of combined diagnosis were higher. Conclusions:Dynamic electrocardiogram combined with serum BNP and CK-MB can better help to evaluate the severity of respiratory tract infection complicated with myocarditis. Therefore, they are worthy of monitoring.

Sepsis is one of the common severe diseases caused by the dysregulated host response to infection， which seriously threatens the life and health of human beings all over the world. The incidence and mortality of the disease are extremely high， and it has always been an urgent problem to be solved in the field of acute and critical diseases. At present， anti-infection， fluid resuscitation， mechanical ventilation and other programs are most used in clinic to treat sepsis， but their poor prognosis and high cost and other issues remain to be resolved. Therefore， it is necessary to explore a new， efficient， safe and inexpensive drug and treatment model at this stage. The treatment of traditional Chinese medicine （TCM） is based on syndrome differentiation and holistic concept. It can effectively regulate the progression of sepsis， maintain the homeostasis of the body， and has fewer adverse reactions. It has achieved good clinical results. In recent years， a large number of studies have shown that TCM can reduce the inflammatory response by regulating the Toll-like receptor 4（TLR4） signaling pathway， thereby reducing the severity and mortality of sepsis patients. However， there is still a lack of systematic exposition of TCM regulating TLR4 signaling pathway in the treatment of sepsis. Therefore， this article summarizes the relationship between TLR4 signaling pathway and sepsis and the mechanism of TCM in the disease by searching and consulting relevant literature in recent years. It is found that some Chinese medicine monomers and active ingredients， Chinese medicine compounds and Chinese medicine preparations can effectively reduce systemic inflammatory response， repair organ damage and improve the prognosis of sepsis by inhibiting the activation of TLR4 signaling pathway. However， due to various limitations， some studies have directly focused on the differential expression and function of TLR4， ignoring the downstream molecular expression and phenotypic effects of TLR4. The alternative mechanism， relationship and specific molecular mechanism of the pathway are still unclear. There are problems such as unclear pharmacokinetics and unclear mechanism in the pro- and anti-inflammatory balance， which need to be further studied and explored in order to provide new ideas for the potential treatment and drug development for sepsis.

Gastroesophageal reflux disease （GERD） is a gastrointestinal motility disorder characterized by the reflux of gastric contents into the esophagus， leading to symptoms such as acid reflux and heartburn. The incidence of GERD is closely associated with psychological disorders， including anxiety and depression. The brain-gut axis， serving as a mediator of the bidirectional connection between the brain and the gastrointestinal tract， plays a crucial role in the occurrence and development of GERD with anxiety and depression. Various therapeutic approaches， including compound Chinese medicine internal therapy （such as Pingchong jiangni decoction， Tiaozhong huashi decoction， etc.）， combination therapy of internal and external Chinese medicine （such as Lianzhi xiere decoction combined with acupoint application， acupuncture at the back segment of governor vessel plus Chinese medication of soothing the liver and gallbladder， etc.）， and combination therapy of internal Chinese and western medicine （including Jianpi shugan decoction combined with rabeprazole， rabeprazole combined with Jianzhong jiangni decoction， etc.）， have been shown to regulate brain-gut peptides， intestinal flora， inflammatory factors and gastrointestinal hormones， thereby effectively alleviating GERD symptoms， anxiety and depression， and enhancing patients’ quality of life.

OBJECTIVE To evaluate the post-marketing safety of Compound porcine cerebroside and ganglioside injection in patients with ischemic stroke. METHODS A drug-induced， prospective， non-controlled clinical study design was conducted. Using the patients with ischemic stroke who received Compound porcine cerebroside and ganglioside injection at least once in 46 secondary class A and above medical institutions across the country from April 2020 to May 2021 as the monitoring objects， and their basic data， medication information and the occurrence of adverse drug reactions were analyzed. RESULTS Among 13 514 patients with ischemic stroke， the incidence of adverse events was 10.01%， and the incidence of adverse reactions related to Compound porcine cerebroside and ganglioside injection was 0.33%. Drug-related adverse drug reactions were mild or moderate， concentrated in the gastrointestinal system （18 cases）， skin and subcutaneous tissue （10 cases）， nervous system （7 cases） and other systems/organs， mainly including constipation， abdominal pain， diarrhea， rash， pruritus， dizziness and other symptoms. Most of the patients （91.03%） recovered or improved after treatment， and 2 patients died. Among the 45 patients with adverse drug reactions， 84.44% were cured or improved after drug withdrawal or symptomatic treatment， and 15.56% had no significant change. The incidence of adverse drug reactions in tertiary hospitals was significantly higher than that in secondary hospitals， and the incidence of adverse drug reactions in patients with allergic history was significantly higher than that in patients without allergic history （P＜0.05）. Irrational drug use was found in 2.76% of patients， and the incidence of adverse drug reactions（2.95%） was significantly higher than that in patients without irrational drug use（0.26%，P＜0.05）. CONCLUSIONS The adverse drug reaction symptoms of ischemic stroke patients treated with Compound porcine cerebroside and ganglioside injection are relatively common， the incidence rate is generally low， and it is related to the patients’ physique and whether the drug use is standardized.

Objective:To investigate the feasibility of classifying imaging patterns of dermatomyositis/polymyositis-related interstitial lung disease (DM/PM-ILD) into subtypes based on chest CT radiomics features and a model was constructed by machine learning algorithms.Methods:From November 2011 to November 2020, 107 patients diagnosed with PM/DM-ILD at the First Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. A total of 315 cases with chest CT were collected. Doctors pre-classified image patterns, including 105 cases with non-specific interstitial pneumonia (NSIP), 90 cases with organizing pneumonia (OP), and 66 cases with non-specific interstitial pneumonia combined with organizing pneumonia (NSIP+OP), 35 cases with common interstitial pneumonia (UIP), and 19 cases with diffuse alveolar damage (DAD), ANOVA was used to test the difference of baseline clinical information among the imaging classification groups. All images were divided into the training set and the est set by stratified random sampling at a ratio of 4∶1. In each CT scan, 3D slicer was used to segment each lung lobe, and then reconstructed into 3 mm 3 of voxels, and Pyradiomics library was used to extract the radiomic features of the whole lung and each lobe. The multi-classification goal was achieved by constructing random forest base classifiers for each of the five groups and then voting as the final model. In the process of constructing the base classifier, firstly, the balance between sample groups was achieved by SMOTETomek comprehensive sampling, and the optimal feature set was selected by independent sample t test and L1 regularized least absolute shrinkage and selection operator (LASSO) regression. In this study, the Radiomics model was constructed based on chest CT radiomics features, and the Radiomics + model was constructed by introducing gender and age information. The base classifier and the integration model use the mean accuracy and the area under the receiver operator characteristics analysis curve (AUC) to evaluate the performance, respectively. Results:There was a statistically significant difference ( P<0.05) between the ages of the NSIP, OP, NSIP+OP, UIP, and DAD groups [(57±13),(53±8),(54±10),(44±11), and (46±8)years old, respectively], F=11.82, P<0.001. In the Radiomics model, for each group of NSIP, OP, NSIP+OP, UIP, and DAD, the AUCs of the training set were 0.87, 0.91, 0.91, 0.96, and 0.99, respectively, and the AUC of the test set were 0.81, 0.82, 0.79, 0.93, 0.89. In the final Radiomics + model, for each group of NSIP, OP, NSIP+OP, UIP, and DAD, the AUCs of the training set were 0.89, 0.91, 0.92, 0.97, and 0.99, respectively, and the AUCs of the test set were 0.84, 0.82, 0.78, 0.94, 0.90. Conclusion:Based on chest CT radiomics features and key clinical features (sex, age), the Radiomics + model constructed by machine learning has good classification performance for the imaging patterns of PM/DM-LD.

Objective: To investigate the association between lifestyle risk factors and comorbidity of chronic diseases among male elderly populations in Oroqen Autonomous Banner, Inner Mongolia Autonomous Region, so as to provide insights into improvements of lifestyles and prevention of comorbidity of chronic diseases among male elderly populations. Methods: Male residents at ages of 65 years and older that participated in community healthy examinations were sampled from 16 villages (communities) in Oroqen Autonomous Banner using a multi-stage cluster random sampling method from July to December, 2020. Participants' demographic data, lifestyle risk factors and disease history were collected using questionnaire surveys, and healthy examinations data were collected through the grassroots healthcare service information system for community health service centers, including waist circumference, blood pressure, fasting blood glucose and blood lipid. The correlation between lifestyle risk factors and comorbidity of chronic diseases were examined among males at ages of 65 years and older using a multivariable ordered logistic regression model. Results: Totally 761 male elderly populations were included, with a mean age of (73.61±6.74) years. There were 216 participants with central obesity (28.38%), 179 with smoking (23.52%), 194 with alcohol consumption (25.49%), 412 with a low frequency of physical activities (54.14%), 347 with one type of lifestyle risk factor (45.60%) and 268 with two and more types of lifestyle risk factors (35.22%), 404 with hypertension, 170 with diabetes and 321 with dyslipidemia. There were 347 participants with one type of chronic disease (45.60%), 199 with two types of chronic diseases (26.15%) and 50 with three types of chronic diseases (6.57%), and the prevalence of comorbidity of chronic diseases was 32.72% among the participants. Multivariable ordered logistic regression analysis showed an increased risk of developing comorbidity of chronic diseases among participants with central obesity (OR=2.442, 95%CI: 1.804-3.307), and a reduced risk of comorbidity of chronic diseases among participants with less than two types of lifestyle risk factors (one type, OR=0.607, 95%CI: 0.451-0.820; none, OR=0.675, 95%CI: 0.460-0.990). Conclusions Central obesity and number of lifestyle risk factors are factors affecting comorbidity of chronic diseases among the male elderly populations at ages of 65 years and older in Oroqen Autonomous Banner.

Objective:To evaluate biological dose and retrospective biodosimetry of a case of large area back skin injury caused by suspected interventional procedure.Methods:Peripheral blood from the patient was collected at about 7 months after interventional procedure, and the chromosomal aberrations in peripheral blood cells were analyzed to evaluate the retrospective biodosimetry using the correction factor of dose estimation, Dolphin′s model and Qdr method, respectively. Results:Based on the amounts of semi-automated dic and manually detected dic plus ring, the whole-body average absorbed dose of the victim was estimated to be 0.68-0.95 Gy by four different dose response curves. Over dispersion of dic or dic plus ring was also detected, and the efficiency of dose assessment was obviously increased using dic semi-automatic detection. Based on three different retrospective biodosimetry models, the estimated average absorbed dose was further corrected to be between 1.80-2.86 Gy, which was consistent with clinical diagnosis of degree Ⅳ radiation skin injury.Conclusions:A case of suspected radiation skin injury was confirmed by chromosomal aberration analysis and it’s biodosimetry was reconstructed, suggesting that the unstable chromosomal aberration analysis may be applicable to assess the retrospective biodosimetry of non-uniform local radiation exposure.

Objective:To investigate the core competency and general self-efficacy status of geriatric nursing assistants in combination of medical treatment and endowment pension institutions and analyze their correlation.Methods:From December 2019 to February 2020, the convenient sampling method was used to select 300 geriatric nursing assistants from 15 combination of medical treatment and endowment pension institutions in Urumqi as the research objects. The general data questionnaire, Geriatric Nursing Assistants' Core Competence Questionnaire and General Self-efficacy Scale (GSES) were used to conduct the questionnaire survey. Pearson correlation analysis and multiple linear regression were used to analyze the relationship between them.Results:A total of 300 questionnaires were distributed and 292 were effectively received, with an effective recovery rate of 97.3%. The total score of core competency of 292 geriatric nursing assistants was (106.44±15.35) , and average score of each item was (3.94±0.57) , which were in the upper middle level. The total score of self-efficacy was (26.95±6.30) , which was in the middle level. Pearson correlation analysis showed that the total score of core competence and scores of various dimensions were positively correlated with the total score of GSES ( r=0.232-0.432, P<0.01) . Multiple linear regression analysis showed that general self-efficacy was the influencing factor of core competence of geriatric nursing assistants (standardized regression coefficient was 0.264, P<0.01) . Conclusions:Self-efficacy is an important influencing factor of core competence of geriatric nursing assistants. Improving the self-efficacy of geriatric nursing assistants can optimize their core competence and help development of the combination of medical and health care pension model.

Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae ( CRE) isolated from children in China. Methods CRE strains were collected in 10 ter-tiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method ( KB method) and automated method. The re-sults were analyzed according to the Clinical and Laboratory Standards Institute ( CLSI) Standards published in 2017. WHONET 5. 6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3065 CRE clinical strains were isolated from children with an overall prevalence of 7. 7％ and among them, 13. 5％ were isolated in neonatal group and 5. 8％ in non-neo-natal group. The detection rate of CRE in 2017 was higher than that in 2016 (9. 7％ vs 5. 7％). Among the 3065 CRE strains, there were 1912 strains of Klebsiella pneumoniae (62. 0％), 667 strains of Escherichia coli (22. 0％), 206 strains of Enterobacter cloacae (7. 0％), 56 strains of Klebsiella aerogenes (1. 8％) and 47 strains of Serratia marcescens (1. 5％). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44. 8％ and 19. 7％, respectively. Respiratory tract (61. 8％), urine (19. 4％) and blood (5. 7％) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79. 6％-100％), especially those isolated in the neonatal group (P<0. 05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19. 7％) and fos-fomycin (11. 9％), fluoroquinolones such as levofloxacin (37. 7％) and ciprofloxacin (43. 3％), and tige-cycline (3. 8％). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug re-sistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken.