Taking the theory of zang-qiao （脏窍， viscera and orifices） as the framework， this paper elaborates on the connotation and expression of the holistic concept of zang-qiao. It expounds the concept from two dimensions， which are "integration of viscera and orifices" and "integration of the seven orifices"， and explains the diagnostic and therapeutic approach characterized by "inferring the condition of the viscera through the orifices and conducting comprehensive diagnosis" in the context of ear， nose， pharynx and larynx diseases. Moreover， it explores specific therapeutic strategies for orifice-related diseases in otorhinolaryngology， including treatment of the orifices via viscera， simultaneous treatment of viscera and orifices， and external therapies targeting the orifices， which provides a multidimensional thinking model and practical path for clinical diagnosis and treatment.

Objective To analyse the concept of subjective financial distress in cancer patients.Methods Papers in regarding the subjective financial distress were retrieved from the databases such as China National Knowledge Infrastructure(CNKI),Wangfang Database,PubMed,Cochrane Library,Web of Science,CINAHL,and Embase from the inceptions to 16th October,2022.Walker and Avant's concept analysis was performed to analyse the acquired articles.Results A total of 48 articles were retrieved and included in the study.Walker and Avant's concept analysis showed that the subjective financial distress in the patients was subject to the 3 defining attributes:perceived economic risk,coping behaviours,and negative emotional reactions.The antecedents of this distress included individual factors,disease and treatment factors,and social factors.The consequences of them were the increase in negative health behaviours and poorer quality of life.Conclusions The attributes,antecedents and consequences of subjective financial distress,as identified through the conceptual analysis,can serve as a reference for subsequent researches.In future studies,it would be beneficial by further exploring the connotation by considering China's healthcare system.

Objective:To explore the optimal pulse oxygen saturation (SpO 2) range during hospitalization for patients with sepsis. Methods:A case-control study design was employed. Demographic information, vital signs, comorbidities, laboratory parameters, critical illness scores, clinical treatment information, and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ). A generalized additive model (GAM) combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO 2 levels during hospitalization and in-hospital all-cause mortality. The optimal range of SpO 2 was determined, and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO 2 and in-hospital all-cause mortality. Results:A total of 5?937 patients met the inclusion criteria, among whom 1?191 (20.1%) died during hospitalization. GAM analysis revealed a nonlinear and U-shaped relationship between SpO 2 levels and in-hospital all-cause mortality among sepsis patients during hospitalization. Multivariable Logistic regression analysis further confirmed that patients with SpO 2 levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO 2 < 0.96 [hypoxia group; odds ratio ( OR) = 2.659, 95% confidence interval (95% CI) was 2.190-3.229, P < 0.001] and SpO 2 > 0.98 (hyperoxia group; OR = 1.594, 95% CI was 1.337-1.900, P < 0.001). Kaplan-Meier survival curve showed that patients with SpO 2 between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO 2 < 0.96 and SpO 2 > 0.98 (Log-Rank test: χ2 = 113.400, P < 0.001). Sensitivity analyses demonstrated that, with the exception of subgroups with smaller sample sizes, across the strata of age, gender, body mass index (BMI), admission type, race, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, body temperature, myocardial infarction, congestive heart failure, cerebrovascular disease, chronic liver disease, diabetes mellitus, sequential organ failure assessment (SOFA), simplified acute physiology score Ⅱ (SAPSⅡ), systemic inflammatory response syndrome score (SIRS), and Glasgow coma score (GCS), the mortality of patients with SpO 2 between 0.96 and 0.98 was significantly lower than those of patients with SpO 2 < 0.96 and SpO 2 > 0.98. Conclusions:During hospitalization, the level of SpO 2 among sepsis patients exhibits a U-shaped relationship with in-hospital all-cause mortality, indicating that heightened and diminished oxygen levels are both associated with increased mortality risk. The optimal SpO 2 range is determined to be between 0.96 and 0.98.

Danshen, the dried roots and rhizomes of Salvia miltiorrhiza Bunge (S. miltiorrhiza), is widely used in the treatment of cardiovascular and cerebrovascular diseases. Tanshinones, the bioactive compounds from Danshen, exhibit a wide spectrum of pharmacological properties, suggesting their potential for future therapeutic applications. Tanshinone biosynthesis is a complex process involving at least six P450 enzymes that have been identified and characterized, most of which belong to the CYP76 and CYP71 families. In this study, CYP81C16, a member of the CYP71 clan, was identified in S. miltiorrhiza. An in vitro assay revealed that it could catalyze the hydroxylation of four para-quinone-type tanshinones, namely neocryptotanshinone, deoxyneocryptotanshinone, and danshenxinkuns A and B. SmCYP81C16 emerged as a potential broad-spectrum oxidase targeting the C-18 position of para-quinone-type tanshinones with an impressive relative conversion rate exceeding 90%. Kinetic evaluations andin vivo assays underscored its highest affinity towards neocryptotanshinone among the tested substrates. The overexpression of SmCYP81C16 promoted the accumulation of (iso)tanshinone in hairy root lines. The characterization of SmCYP81C16 in this study accentuates its potential as a pivotal tool in the biotechnological production of tanshinones, either through microbial or plant metabolic engineering.
Humans ; Salvia miltiorrhiza/metabolism* ; Biosynthetic Pathways ; Quinones/metabolism* ; Plant Roots/metabolism* ; Gene Expression Regulation, Plant

Objective To investigate the correlation between ITPKB mutation's variant allele frequency (VAF) and prognosis of diffuse large B-cell lymphoma (DLBCL). Methods This study included 155 patients with DLBCL initially diagnosed in the People's Hospital of Xinjiang Uygur Autonomous Region from June 2014 to December 2020. Paraffin-embedded tumor tissue specimens were obtained, and tumor tissue DNA was extracted. A total of 475 hotspot genes including ITPKB were detected by the next generation sequencing to analyze the relationship of the VAF of high-frequency mutant gene with progression-free survival (PFS) and overall survival (OS). Results The mutation frequency of ITPKB was 18.71%. The PFS was significantly shorter in the patients with ITPKB mutations than in those without mutations (37 months vs. 108 months; HR=1.643, 95%CI: 0.920-2.934, P=0.093). The R-language based web tool was used to find the best VAF cutoff to differentiate prognosis. The patients were divided into two groups (VAF High vs. VAF Low+Wt) according to their VAF values. The optimal VAF threshold for ITPKB was 27.48% (HR=3.480, 95%CI: 1.70-7.13, P=0.00027). Multivariate Cox analysis was conducted using clinical indicators such as age, gender, COO classification, IPI, and LDH, and the results showed that PFS was associated with high ITPKB VAF (≥28%) (HR=3.592, 95%CI: 1.738-7.425, P < 0.001) which was an independent adverse predictor of PFS. Conclusion The high load of ITPKB mutation is an independent risk factor for the PFS of patients with DLBCL, and the VAF of ITPKB mutation has a prognostic predictive value for patients with DLBCL.

Objective:To explore the predictive value of systemic immune inflammation index (SII) for the risk of hospital death in critically ill patients.Methods:The basic information and clinical data of critically ill patients were extracted from the Medical Information Mart for Intensive Care database-Ⅳ (MIMIC-IV) database, including demographic data, vital signs, blood routine, Logistic organ dysfunction score (Lods), Oxford acute severity of illness score (Oasis), simplified acute physiology score (Saps-Ⅱ), acute physiology score Ⅲ (APS-Ⅲ), sequential organ failure score (SOFA) and outcome. The main outcome was hospital death, and the secondary outcomes were length of hospital stay, continuous renal replacement therapy (CRRT), invasive ventilation and 1-year mortality. Patients were divided into two groups according to in-hospital death, and the differences between the groups were compared. According to the SII tripartite for inter-group comparison, the patients were further divided into three groups for comparison, and Logistic regression model was used to analyze the odd ratio ( OR) of the three groups. Results:A total of 32 450 critically ill patients were included in the study, of which 3765 died in hospital, with a mortality rate of 11.6%. ① Compared with the survival group, the SII in the death group were significantly higher ( P < 0.05). ② The mortality for the SII tripartite grouping (<817; 817~2 151; >2 151) were 8.4%, 10.2% and 16.3%, respectively, and the differences between groups were statistically significant. ③ Further, Logistic regression model analysis showed that the risk of death increased gradually with the increase of groups (the first group was the reference group, OR of the second group was 1.38, 95% CI 1.24-1.54, and OR of the third group was 2.03, 95% CI 1.83-2.24 ( P < 0.05). Conclusions:SII has a certain value in predicting hospital death in critically ill patients. It is easy to obtain and can be used for risk stratification of critically ill patients.

Financial toxicity is widely present among caregivers of cancer patients and has adverse effects on the health outcomes of patients and their caregivers. This article reviews the relevant concepts, current status and impacts, evaluation tools, influencing factors, and interventions of financial toxicity of caregivers for cancer patients, aiming to provide a basis for the research on financial toxicity of caregivers for cancer patients.

Objective:To establish a model of epiphyseal plate injury in juvenile rabbits and explore the effect of periosteum flap with saphenous artery on preventing the formation of bone bridge after epiphyseal plate injury.Methods:From July 2017 to January 2018, 30 young New Zealand immature rabbit were randomly grouped into 3 groups (group A, B and C, with 10 rabbits per group). The blood vessels of knee joint were dissected and a periosteum flap with saphenous artery were designed. A model of distal femoral epiphyseal plate injury was established in immature rabbits with a 3.0 mm Kirschner wire on one side of the distal femoral epiphyseal plate as experimental side, and the other side of the distal femoral epiphyseal plate was assigned as control side. The injured epiphysis were prepared and described as follow: in experimental side of group A, a piece of periosteum with the same size as that in group C was resected and discarded. In experimental side of group B, a periosteal flap without vascular pedicle was filled in the injured area. And in experimental side of group C, a periosteum flap with saphenous artery was filled in the injured area. The length and varus angle of femur specimens of length and varus angle of femur specimens wihthin groups were measured at 24 weeks after surgery to evaluate the effect on bone growth in epiphyseal plate injury. The effect of the periosteum flap with saphenous artery on preventing a formation of bone bridge was assessed by section view of decalcified specimens, HE staining and toluidine blue staining. The measured data were expressed as Mean and standard deviation (Mean±SD), and data were compared within and between the groups using one-way analysis of variance (ANOVA). P<0.05 was considered as statistically significant. Results:The femur of experimental side of group A and B showed obvious short with valgus deformity compared with that of control side, and the difference of length and varus angle of femur specimens wihthin groups was statistically significant ( P<0.05). There were no significant differences in the length and valgus angle of the femur between experimental side and its control side in group C ( P>0.05). In experimental side of group A, there were bone bridges in the epiphyseal lesion area, with a clear boundary to the surrounding epiphyseal plate. In experimental side of group B, the periosteum flap in the injured area was absorbed, accompanied by the formation of a few pale white bone tissue, and with a clear boundary to the surrounding epiphyseal plate. In experimental side of group C, the lesion area was filled with milky white cartilage tissue with the same colour as the epiphyseal plate, and with an unclear boundary with the epiphyseal plate. HE stain and toluidine blue staining showed that the injured area of group A was filled with a large number of bone tissue, but no obvious cartilage tissue was observed. In group B, the area of lesion was filled mainly with fibrous tissue, with a small amount of bone tissue. In group C, a large number of hyaline cartilage tissues were formed along the tunnel of the injury area, and closely connected with the normal epiphyseal plate. Conclusion:Filling a periosteum flap with saphenous artery after epiphyseal plate injury can prevent the formation of bone bridge and prevent the affected limb form shortening and angulation.

Objective:To explore the effect of cloud follow-up system in post-hospital follow-up management of hyperuricemia gout patients.Methods:Using the convenient sampling method, a total of 120 gout patients who were discharged after treatment in Taizhou Central Hospital in June 2021 were selected as the research objects and they were randomly divided into the control group and the experimental group according to the random number table method, with 60 cases in each group. The control group carried out routine follow-up, while the experimental group carried out follow-up based on cloud follow-up system. The serum uric acid level and self-management ability of gout patients were compared between the two groups before and after 6 months of follow-up.Results:After 6 months of follow-up, the serum uric acid levels of the control group and the experimental group were lower than those before follow-up and that of the experimental group was lower than the control group, and the differences were statistically significant ( P<0.05) . After 6 months of follow-up, the self-management ability score of the experimental group was higher than that before follow-up and higher than that after follow-up of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The new follow-up model based on cloud follow-up system is helpful to improve the self-management ability of gout patients and reduce the blood uric acid level of gout patients.

Background: High-dose dual therapy (HDDT) is a novel regimen for the eradication of Helicobacter pylori (Hp) infection, however, its efficacy and safety remain unclear. Aims: To evaluate the efficacy, safety and compliance of HDDT for Hp eradication. Methods: Randomized controlled trials (RCTs) on HDDT for eradication of Hp infection were retrieved from PubMed, Embase, The Cochrane Library, Web of Science from the date of database establishment to October 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the data were extracted. RevMan 5.2 software was used for performing meta-analysis. Results: Nine RCTs including 2 627 patients were included. Meta-analysis results showed that no significant differences in ITT eradication (85.4% vs. 79.8%, RR=1.03, 95% CI: 0.96-1.10, P=0.40), PP eradication (88.7% vs. 83.4%, RR=1.01, 95% CI: 0.95-1.08, P=0.68), and compliance (96.5% vs. 95.9%, RR=1.01, 95% CI: 0.99-1.02, P=0.37) were found between HDDT and the guideline-recommended regimens, however, the incidence of adverse events was significantly decreased in HDDT (15.3% vs. 27.0%, RR=0.57, 95% CI: 0.42-0.76, P=0.000 2). Conclusions: There are no significant differences in eradication rates and compliance between HDDT and the guideline-recommended regimens, however, HDDT is much safer.