The theory of " heart governing the exterior" derives from Prohibition of Pricking in Suwen, which has an important position in the clinical practice of traditional Chinese medicine. This article sorts out the interpretation of " heart governing the exterior" of physicians in the past dynasties, and summarizes the clinical application of " heart governing the exterior" in chest painful impediment, warm disease, dermatosis, allergic rhinitis, tic disorder, and diabetic neuropathy. It is found that the theory of " heart governing the exterior" is widely used in clinical practice and has good effects. This paper further expands and enhances its theoretical connotation, that is, the physiological and pathological connection and clinical application of the three dimensions of heart yang, heart blood, and heart spirit with the life and mental activities dominated by it, as well as the overall external performance. In addition, by exploring the relationship between " heart governing the exterior" and " brain-heart axis" , " brain-skin axis" in Western medicine, it indirectly confirms the rationality of " heart governing the exterior" in Western medicine, and lays the foundation for the further development and application of the theory of " heart governing the exterior" .

Objective To understand the timeliness of antiretroviral therapy (ART) in newly reported HIV/AIDS cases in Yichang from 2016 to 2022 and its influencing factors, and to provide a scientific basis for improving the timeliness of ART in Yichang City. Methods HIV/AIDS cases data from January 1, 2016 to December 31, 2022 were collected, and chi-square tests and logistic regression were used to analyze the factors influencing the timeliness of ART. Results A total of 1 126 HIV/AIDS cases were collected, with local reported cases accounting for 83.13%. The male to female ratio was 5.15:1. The median age was 42 years old (28-53 years old). 41.03% of the cases were unmarried. 38.99% of cases had a first-time CD4+T lymphocytes (CD4 cells) count < 200 cells/µL. Cases with timely first CD4 cell test accounted for 67.85%. The overall timely rate of ART from 2016 to 2022 was 57.19%, with a median time from diagnosis to initiation of ART of 20 days. There was no statistically significant difference in the trend of ART timely rate from 2016 to 2022 (P=0.251). Cases with timely first CD4 cell test were more likely to initiate ART in time (OR=3.831, 95% CI:2.454-5.981), while cases reported from other areas (OR=0.497, 95% CI:0.345-0.716) and cases with higher first CD4 cell count levels (OR_≥500=0.473, 95% CI:0.312-0.718) were less likely to initiate ART in time. Conclusion The timely rate of antiviral treatment in Yichang City needs to be further improved. High attention should be paid to cases reported from other places, cases with delayed CD4 cell testing, and cases with high CD4 cell count levels. Treatment mobilization and referral should be done well, and early detection services should be provided in time.

Objective To analyze the characteristics of traditional Chinese medicine(TCM)in the prevention and treat-ment of schistosomiasis using data mining techniques and summarize the evolution trend.Methods Using keywords including"schistosomiasis"and"traditional Chinese medicine"or"TCM treatment"or"TCM university"or"TCM syndrome differentia-tion"or"TCM clinical practice",we systematically retrieved and screened relevant literature from the China National Knowledge Infrastructure(CNKI)and WanFang Database from the inception to April 21,2024.Data mining techniques were employed to conduct a descriptive analysis and a correlation analysis on the included literature.Results A total of 381 articles that met the criteria were screened,with the highest number of publications occurring in January.Academic journals were the main source of information,accounting for approximately 88.98％of the total.Additionally,541 authors were involved,with hospitals being the most predominant author affiliations.Keyword co-occurrence analysis showed that the main research hotspots included schistoso-miasis,liver fibrosis,public health,and prevention.Conclusion Based on statistical research of the literature using data min-ing techniques,this study provided an in-depth analysis of the characteristics and development trend of TCM in prevention and treatment of schistosomiasis.It offers theoretical guidance and practical references for future related research and practices.

Hemodynamically unstable pelvic fracture is an important cause of trauma-related deaths and its treatment presents a major challenge for trauma surgery. Internal iliac artery devascularization including ligation and embolization of the internal iliac artery with occlusion of the internal iliac artery as their hemostatic mechanism, has been proved to be effective in controlling massive hemorrhage after pelvic fracture. Nevertheless, there still remain substantial differences in the understanding of internal iliac artery devascularization in clinical practice. Some and issues that should be paid attention to its emergency application in the management of hemodynamically unstable pelvic fracture have not been fully elucidated. To this end, the authors emphasized the efficacy and safety of internal iliac artery devascularization, its indications, and key points in implementation, aiming to promote its standardized application in the treatment of hemodynamically unstable pelvic fracture, thus improving treatment outcomes.

It is discovered that activated caspase-3 tends to induce apoptosis in gasdermin E (GSDME)-deficient cells, but pyroptosis in GSDME-sufficient cells. The high GSDME expression and apoptosis resistance of pancreatic ductal adenocarcinoma (PDAC) cells shed light on another attractive strategy for PDAC treatment by promoting pyroptosis. Here we report a hGLuc-hGSDME-PCA system for high-throughput screening of potential GSDME activators against PDAC. This screening system neatly quantifies the oligomerization of GSDME-N to characterize whether pyroptosis occurs under the stimulation of chemotherapy drugs. Based on this system, ponatinib and perifosine are screened out from the FDA-approved anti-cancer drug library containing 106 compounds. Concretely, they exhibit the most potent luminescent activity and cause drastic pyroptosis in PDAC cells. Further, we demonstrate that perifosine suppresses pancreatic cancer by promoting pyroptosis via caspase-3/GSDME pathway both in vitro and in vivo. Collectively, this study reveals the great significance of hGLuc-hGSDME-PCA in identifying compounds triggering GSDME-dependent pyroptosis and developing promising therapeutic agents for PDAC.

Medical record writing in trauma surgery differs from that of conventional surgery. The medical records in trauma surgery encompass the entire process of trauma management, serving as an indication of expertise in trauma management and treatment effectiveness. At present, most medical records in trauma surgery are written in the conventional writing mode of various surgical specialties, which fails to indicate the overall injury situation of trauma patients and the process of diagnosis and treatment, resulting in unevenly qualified medical records in trauma surgery, which hinders trauma treatment and academic exchange. Given that trauma assessment owns unique nuances, conventional physical examination methods are not entirely applicable to trauma patients. Moreover, with the advancement of diagnostic and therapeutic technologies, certain physical examination techniques and medical procedures that may induce pain, impede timely rescue, or even cause injury can be circumvented in clinical assessment. As theories, techniques, and disciplines in trauma care continue to develop, there arises a need for further standardization and uniformity in medical record writing in trauma surgery. By analyzing the special characteristics of medical record writing in trauma surgery, the authors sorted out and summarized the problems in medical record writing and put forward suggestions on improvement of medical records in trauma surgery to provide reference for standardization of medical record writing in trauma surgery and improvement of the comprehensive strength of trauma treatment.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

BACKGROUND: The presence of fibrosis is a criterion for subtype classification in the newly updated hypersensitivity pneumonitis (HP) guidelines. The present study aimed to summarize differences in clinical characteristics and prognosis of non-fibrotic hypersensitivity pneumonitis (NFHP) and fibrotic hypersensitivity pneumonitis (FHP) and explore factors associated with the presence of fibrosis. METHODS: In this prospective cohort study, patients diagnosed with HP through a multidisciplinary discussion were enrolled. Collected data included demographic and clinical characteristics, laboratory findings, and radiologic and histopathological features. Logistic regression analyses were performed to explore factors related to the presence of fibrosis. RESULTS: A total of 202 patients with HP were enrolled, including 87 (43.1%) NFHP patients and 115 (56.9%) FHP patients. Patients with FHP were older and more frequently presented with dyspnea, crackles, and digital clubbing than patients with NFHP. Serum levels of carcinoembryonic antigen, carbohydrate antigen 125, carbohydrate antigen 153, gastrin-releasing peptide precursor, squamous cell carcinoma antigen, and antigen cytokeratin 21-1, and count of bronchoalveolar lavage (BAL) eosinophils were higher in the FHP group than in the NFHP group. BAL lymphocytosis was present in both groups, but less pronounced in the FHP group. Multivariable regression analyses revealed that older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors for the development of FHP. Twelve patients developed adverse outcomes, with a median survival time of 12.5 months, all of whom had FHP. CONCLUSIONS Older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors associated with the development of FHP. Prognosis of patients with NFHP was better than that of patients with FHP. These results may provide insights into the mechanisms of fibrosis in HP.
Humans ; Bronchoalveolar Lavage Fluid ; Prospective Studies ; Alveolitis, Extrinsic Allergic/diagnosis* ; Fibrosis ; Carbohydrates

Multiple trauma is complex and difficult to treat. The trauma at each site may obscure or delay the manifestation of each other. The severity of injury also exceeds the simple superposition of each injured site. There are numerous definitions of multiple trauma worldwide, with most regarding multiple trauma as major trauma. The definition of multiple trauma in China has evolved several times; however, it is currently still controversial, especially on whether the definition should be based on the nine body regions of the Abbreviated Injury Scale (AIS) or the six body regions of the Injury Severity Score (ISS). The absence of uniform anatomic region criteria in the definition of multiple trauma can lead to discrepancies in multiple trauma patients, causing the clinical application of the definition to be problematic. In this study, the authors elaborate the development and application status of the defination of multiple trauma at home and abroad, discuss the existed problems or controversies and put forward feasible suggestions on the definition of multiple trauma to further normalize the diagnosis and treatment of multiple trauma.

Flail chest is a severe chest trauma that is commonly associated with lung contusion, resulting in acute respiratory distress syndrome and respiratory failure, which brings challenges in clinical management. It has become a clinical consensus that surgical treatment of flail chest can rapidly restore thoracic stability, eliminate paradoxical breathing, and maintain stability of respiratory and circulatory functions. However, non-surgical interventions continue to be crucial in further improving the prognosis of patients with flail chest, such as pain management and respiratory management. In this study, the authors review the research progress in pain control and respiratory management during comprehensive treatment of patients with flail chest for better understanding of pain management and lung injury care, which may provide references for clinical treatment and further improvement of clinical prognosis and quality of life for patients with flail chest.