Objective To evaluate the bioequivalence and safety of ezetimibe tablets in healthy Chinese subjects.Methods The study was designed as a single-center,randomized,open-label,two-period,two-way crossover,single-dose trail.Subjects who met the enrollment criteria were randomized into fasting administration group and postprandial administration group and received a single oral dose of 10 mg of the subject presparation of ezetimibe tablets or the reference presparation per cycle.The blood concentrations of ezetimibe and ezetimibe-glucuronide conjugate were measured by high-performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS),and the bioequivalence of the 2 preparations was evaluated using the WinNonlin 7.0 software.Pharmacokinetic parameters were calculated to evaluate the bioequivalence of the 2 preparations.The occurrence of all adverse events was also recorded to evaluate the safety.Results The main pharmacokinetic parameters of total ezetimibe in the plasma of the test and the reference after a single fasted administration:Cmax were(118.79±35.30)and(180.79±51.78)nmol·mL-1;tmax were 1.40 and 1.04 h;t1/2 were(15.33±5.57)and(17.38±7.24)h;AUC0-t were(1 523.90±371.21)and(1 690.99±553.40)nmol·mL-1·h;AUC0-∞ were(1 608.70±441.28),(1 807.15±630.00)nmol·mL-1·h.The main pharmacokinetic parameters of total ezetimibe in plasma of test and reference after a single meal:Cmax were(269.18±82.94)and(273.93±87.78)nmol·mL-1;Tmax were 1.15 and 1.08 h;t1/2 were(22.53±16.33)and(16.02±5.84)h;AUC0_twere(1 463.37±366.03),(1 263.96±271.01)nmol·mL-1·h;AUC0-∞ were(1 639.01±466.53),(1 349.97±281.39)nmol·mL-1·h.The main pharmacokinetic parameters Cmax,AUC0-tand AUC0-∞ of the two preparations were analyzed by variance analysis after logarithmic transformation.In the fasting administration group,the 90％CI of the log-transformed geometric mean ratios were within the bioequivalent range for the remaining parameters in the fasting dosing group,except for the Cmax of ezetimibe and total ezetimibe,which were below the lower bioequivalent range.The Cmax of ezetimibe,ezetimibe-glucuronide,and total ezetimibe in the postprandial dosing group was within the equivalence range,and the 90％CI of the remaining parameters were not within the equivalence range for bioequivalence.Conclusion This test can not determine whether the test preparation and the reference preparation of ezetimibe tablets have bioequivalence,and further clinical trials are needed to verify it.

OBJECTIVE To observe the clinical efficacy and effect on serum thymic stromal lymphopoietin(TSLP)levels of pa-tients with advanced liver cancer of qi deficiency and toxic stasis type by Jiawei Yupingfeng San.METHODS Using random double blind method,120 patients with advanced liver cancer of qi deficiency and toxic stasis type were randomly divided into 3 groups:Jiawei Yupingfeng San group,Yupingfeng San group,and placebo group,each consisting of 40 cases.All patients in the 3 groups were given conventional treatment such as radiotherapy,chemotherapy,interventional or targeted therapy;Jiawei Yupingfeng San group was given Jiawei Yupingfeng San granules,Yupingfeng San group was given Yupingfeng San granules,and placebo group was given placebo.The course of treatment was 2 months.The changes of Karnofsky functional status score(KPS score),TCM syndrome score,tumor size and serum TSLP level in the 3 groups were observed before and after treatment,and the correlation between the changes of tumor size and TSLP was analyzed.RESULTS After treatment,the KPS scores of Yupingfeng San group and Jiawei Yupingfeng San group were sig-nificantly increased(P<0.05,P<0.01),TCM syndrome score were decreased(P<0.01),tumor growth(P<0.05,P<0.01)was de-layed,and serum TSLP levels(P<0.05,P<0.01)were decreased.Furthermore,there was a slight positive correlation between chan-ges in tumor size and changes in TSLP(P<0.05).In terms of improving tumor size,the curative effect of Jiawei Yupingfeng San group was better than that of Yupingfeng San group(P<0.05).During the treatment period,no obvious adverse reactions were observed in the 3 groups of patients.CONCLUSION Combined with conventional treatment,Jiawei Yupingfeng San can significantly delay tumor growth in patients with advanced liver cancer of qi deficiency and toxic stasis type and improve patients'TCM syndromes and their qual-ity of survival.The therapeutic mechanism is related to reducing the expression of serum TSLP and improving the immune status of pa-tients,thereby delaying the growth of tumors.

Objective:To explore the mediating effect of breastfeeding self-regulation on the relationship between breastfeeding self-efficacy and breastfeeding adaptation in parturient women.Methods:Totally 310 parturient women who visited the postpartum clinic at Wuxi Maternity and Child Health Care Hospital from May to September 2023 were selected by convenience sampling. The participants were surveyed using a General Information Questionnaire, the Breastfeeding Self-Regulation Questionnaire (BSRQ), the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), and the Breastfeeding Adaptation Scale (BFAS). The mediating effect of breastfeeding self-regulation between breastfeeding self-efficacy and breastfeeding adaptation was tested using the Process macro and Bootstrap method.Results:The scores for the 310 parturient women were 16.83 (13.83, 19.67) for BSRQ, (45.20±12.38) for BSES-SF, and 107.50 (96.00, 118.00) for BFAS. Spearman correlation analysis showed that breastfeeding self-efficacy was positively correlated with breastfeeding self-regulation and breastfeeding adaptation ( rs=0.314, 0.673; P<0.01), and breastfeeding self-regulation was positively correlated with breastfeeding adaptation ( rs=0.618; P<0.01). The mediating effect of breastfeeding self-regulation between breastfeeding self-efficacy and breastfeeding adaptation was 0.149, accounting for 21.88% of the total effect. Conclusions:Breastfeeding self-regulation mediates the relationship between breastfeeding self-efficacy and breastfeeding adaptation in parturient women. In early postpartum breastfeeding management, healthcare professionals should take measures to improve breastfeeding self-efficacy, help parturient women enhance their self-regulation abilities, and thereby improve their breastfeeding adaptation.

Objective To investigate the effect of early nerve interventional embolization after ruptured intracranial aneurysm(IA)and its effect on nerve function.Methods A total of 100 patients with ruptured IA who underwent neurointerventional embolization in our hospital from January 2020 to January 2023 were selected and divided into two groups according to the timing of surgery.The control group(n=49)underwent surgery 24-72 hours after rupture of 1A,while the study group(n=51)underwent surgery within 24 hours after rupture of IA.The success rate of embolization,serum inflammatory stress factor[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),D-dimer(D-D),malondialdehyde(MDA)],cerebrovascular spasticity(CVS)related factors[hypoxia-inducing factor 1α(HIF-1α)],soluble intercellular adhesion molecule-1(SICAM-1),cysteine aspartate proteolytic enzyme 3(Caspase-3),neurological function(NIHSS score),capacity of daily living(BI score),complications(cerebral vasospasm)and short-term prognosis were compared between the two groups.Results The success rate of embolization in the study group was 94.12％,which was higher than that in the control group(79.59％)(P＜0.05).The serum IL-6 levels in the study group on day 1,3,and 7 after surgery were(18.06±5.11)ng/L,(17.15±4.60)ng/L,and(16.37±4.35)ng/L,respectively,while those in the control group were(23.18±5.92)ng/L,(21.23±5.54)ng/L,and(20.16±5.29)ng/L,respectively,the TNF-α levels were(32.01±7.19)ng/ml,(30.67±6.85)ng/ml,and(29.45±6.63)ng/ml,respectively,while those in the control group were(39.01±8.20)ng/ml,(36.22±7.53)ng/ml,and(35.01±7.12)ng/ml,respectively,the D-D levels were(27.19±4.89)μg/ml,(26.20±4.71)μg/ml,and(25.81±4.39)μ g/ml,respectively,while those in the control group were(32.06±5.94)μg/ml,(31.18±5.49)μg/ml,and(30.26±5.61)μg/ml,respectively,the MDA levels were(2.81±0.83)μmol/ml,(2.53±0.75)μmol/ml,and(2.46±0.71)μmol/ml,respectively,while those in the control group were(4.02±1.01)μmol/ml,(3.84±0.91)μmol/ml,and(3.59±0.86)μmol/ml,respectively,and the differences between the two groups were statistically significant(P＜0.05);on postoperative day 1,3,and 7,the serum HIF-1α levels in the study group were(95.16±8.21)pg/ml,(93.25±7.94)pg/ml,and(92.54±7.80)pg/ml,respectively,while those in the control group were(102.31±8.56)pg/ml,(100.27±8.19)pg/ml,and(99.65±7.92)pg/ml,respectively,the SICAM-1 levels were(620.15±78.92)ng/ml,(616.37±75.28)ng/ml,and(610.92±73.69)ng/ml,respectively,while those in the control group were(683.19±80.24)ng/ml,(680.24±78.51)ng/ml,and(675.31±75.92)ng/ml,respectively,the caspase-3 levels were(645.13±88.61)mg/ml,(640.21±85.76)mg/ml,and(633.79±82.65)mg/ml,respectively,while those in the control group were(720.13±90.54)mg/ml,(717.03±88.65)mg/ml,and(712.81±85.04)mg/ml,respectively,and there were significant differences between the two groups(P＜0.05);the NIHSS scores of the study group at 1 month and 3 months after surgery were(5.20±1.37)scores and(5.03±1.32)scores,respectively,while those of the control group were(6.31±1.50)scores and(6.17±1.45)scores,respectively,the BI scores were(78.01±5.73)scores and(79.12±5.81)scores,respectively,while those of the control group were(72.69±5.50)scores and(73.24±5.72)scores,respectively,and the difference between the two groups was statistically significant(P＜0.05).The incidence of complications in the study group was 7.84％,which was lower than that of the control group(22.45％)(P＜0.05).The good prognosis rate in the study group was 82.35％,which was higher than that of the control group(61.22％)(P＜0.05).Conclusion Neurological intervention and embolization within 24 hours after rupture of IA has significant therapeutic effects and can more effectively improve patients'neurological function and prognosis.

Sepsis is a potentially fatal condition characterized by the failure of one or more organs due to a disordered host response to infection. The development of sepsis is closely linked to immune dysfunction. As a result, immunotherapy has gained traction as a promising approach to sepsis treatment, as it holds the potential to reverse immunosuppression and restore immune balance, thereby improving the prognosis of septic patients. However, due to the highly heterogeneous nature of sepsis, it is crucial to carefully select the appropriate patient population for immunotherapy. This review summarizes the current and evolved treatments for sepsis-induced immunosuppression to enhance clinicians' understanding and practical application of immunotherapy in the management of sepsis.

Objective:To explore the mediating effect of postpartum depression in fathers on their parenting competence and breastfeeding support.Methods:From March to October 2022, convenience sampling was used to select 337 fathers of infants aged 4 to 8 weeks in Wuxi Women and Enfants Care Hospital as the research subject. A survey was conducted using the Edinburgh Postnatal Depression Scale (EPDS), Chinese version of Parenting Sense of Competence Scale (C-PSOC), and maternal spouse version Partner Breastfeeding Influence Scale (PBIS). Spearman correlation was used to explore the correlation between postpartum depression in fathers and their parenting competence and breastfeeding support, and the PROCESS plugin was used for mediation effect testing.Results:A total of 337 questionnaires were distributed and 337 were collected, including 314 valid questionnaires with an effective response rate of 93.18% (314/337). Among 314 infant fathers, the EPDS, C-PSOC, and maternal spouse version PBIS scores were 3.00 (2.00, 6.00), 66.00 (62.00, 71.00), and 83.00 (74.00, 90.00), respectively. Father's parenting competence was negatively correlated with father's postpartum depression ( r=-0.435, P<0.01), and positively correlated with father's breastfeeding support ( r=0.480, P<0.01). Father's postpartum depression was negatively correlated with father's breastfeeding support ( r=-0.423, P<0.01). The mediating effect analysis showed that the mediating effect of postpartum depression in fathers between parenting competence and breastfeeding support was 0.341, accounting for 39.51% of the total effect. Conclusions:Postpartum depression in fathers is a mediating variable between their parenting competence and their breastfeeding support. Medical and nursing workers should develop perinatal education programs for fathers, enhance their parenting competence, alleviate their negative emotions, and promote their breastfeeding support.

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.

Objective:To construct and validate a risk-scoring model for predicting delayed onset of lactogenesis stage Ⅱ (DOL Ⅱ) in mothers separated from their premature infants.Methods:This was a retrospective study. (1) Modeling group: This group enrolled 310 mothers who were separated from their premature infants after delivery at Wuxi Maternal and Child Health Hospital from December 2021 to November 2022. They were further divided into the DOL Ⅱ group (144 cases) and the non-DOL Ⅱgroup (166 cases) according to whether they had DOL Ⅱ or not. Based on the results of multivariate logistic regression analysis, each risk factor was assigned a score, and a risk prediction scoring model was established. (2) Validation group: This group included 130 mothers of premature infants who experienced mother-infant separation after delivery at Wuxi Maternal and Child Health Hospital from December 2022 to March 2023. The area under the receiver operating characteristic (ROC) curve was used to evaluate the discrimination, and the Hosmer-Lemeshow test was used to assess the goodness of fit. The Chi-square test (or Fisher's exact probability test) or Wilcoxon rank sum test were used for inter-group data comparison. Results:This risk prediction scoring model included 10 risk factors [maternal age≥35 years old, hypertensive disorders of pregnancy, anemia, gestational diabetes mellitus, preterm rupture of membrane, start breastfeeding >6 hours, postpartum admission of maternal intensive care unit, cesarean section, score of Edinburgh Postpartum Depression Scale >9.5, postpartum neutrophil-to-lymphocyte ratio ≥4.369, Fatigue Scale-14 ≥7.5, body mass index in the first trimester ≥23.719 kg/m 2, postpartum BMI≥27.661 kg/m 2,and increase of BMI during pregnancy ≥5.393 kg/m 2], with an area under the ROC curve of 0.838 (95% CI: 0.795-0.882, P<0.001), a maximum Yoden index of 0.526, a specificity of 0.825, a sensitivity of 0.701, and an optimal threshold of 4.5. After rounding the score off to the nearest whole number, those with a score≥5 were defined as at high risk of DOL Ⅱ, while those with a score<5 were at low risk. Hosmer-Lemeshow test showed χ2=3.43 and P=0.634. The positive predictive value, the negative predictive value, and the accuracy were 77.7%, 76.1%, and 76.8%, respectively. In the modeling group, 130 out of the 310 cases (41.9%) were predicted to be at high risk by the model with 101 (32.6%) experiencing DOL Ⅱ, while 180 cases (58.1%) were predicted to be at low risk with 43 (13.9%) experiencing DOL Ⅱ. Among the 130 cases in the validation group, 59 (45.4%) were predicted to be at high risk with 39 (30.0%) experiencing DOL Ⅱ, while 71 (54.6%) were predicted to be at low risk with 19 (14.6%) experiencing DOL Ⅱ. The model validation results showed that the area under the ROC curve was 0.774 (95% CI: 0.693-0.855, P<0.001) and the Hosmer-Lemeshow test showed χ2=3.09 and P=0.687, with the positive predictive value of 66.1%, the negative predictive value of 73.2%, and the accuracy of 70.0%. Conclusions:This study preliminarily establishes a risk scoring model for predicting DOL Ⅱ in mothers separated from their premature infants which is of certain predictive value and can provide a reference for developing predictive lactation support measures.

Liver size is regulated by circadian clock and exhibits a diurnal rhythm. Pregnane X receptor (PXR) and peroxisome proliferator-activated receptor α (PPARα), members of nuclear receptor superfamily, are important regulators of liver size. We previously demonstrated that mPXR agonist pregnenolone 16α-carbonitrile (PCN) and mPPARα agonist pirinixic acid (WY-14643) promoted liver enlargement and liver regeneration after partial hepatectomy. However, whether PXR or PPARα activation-induced liver enlargement exhibits diurnal rhythm with normal liver diurnal oscillations remains unclear. The aim of this study was to investigate the diurnal rhythm of PXR or PPARα activation-induced liver enlargement. Male C57BL/6 mice were intraperitoneally injected with corn oil, PCN or WY-14643 for three days, and liver samples were weighed and collected at various time points for analysis. The animal experiment protocol was reviewed and approved by Institutional Animal Care and Use Committee of Sun Yat-sen University (approval No. SYSU-IACUC-2023-001613, SYSU-IACUC-2023-001783). The results showed that PXR or PPARα activation at various time points significantly induced liver enlargement, and liver size maintained normal diurnal oscillations during PXR or PPARα activation-induced hepatomegaly, without significant effects on the expression of core clock genes. This study reveals PXR or PPARα activation-induced liver enlargement exhibits diurnal rhythm with normal liver diurnal oscillations, and provides novel data for nuclear receptor-induced liver enlargement and liver diurnal rhythm.

Objective:To evaluate left ventricular structural and functional abnormalities and vascular calcification in kidney transplant (KT) recipients, explore their influencing factors and examine the effects of mineral and bone disorders.Methods:From January 2017 to December 2019, retrospective analysis was performed for 292 KT recipients. Biochemical markers of bone metabolism, bone mineral density (BMD), left ventricular hypertrophy (LVH), left ventricular ejection fraction (LVEF), left ventricular diastolic function, coronary artery calcification (CAC) score and thoracic aortic calcification (TAC) score were assessed. Linear regression and binary Logistic regression analyses were employed for evaluating the influencing factors of cardiovascular parameters and the influence of abnormal mineral and bone metabolism.Results:Postoperative abnormalities in mineral and bone disorders were manifested mostly as hypercalcemia (8.9%, 26/292), hypophosphatemia (27.1%, 79/292), low 25-hydroxyvitamin D (25(OH)vitD) (67.0%, 196/292), hyperparathyroidismhigh parathyroid hormone (PTH) (50.6%, 148/292), elevated bone turnover markers and bone loss rate of 25%-30%. The prevalence of LVH, LVEF<50%, left ventricular diastolic dysfunction, high CAC score and high TAC score were 39.9%(116/292), 0%, 13.1%(38/292), 17.3%(50/292) and 39.9%(116/292) respectively. The results of multivariate analysis indicated that LVH was correlated positively with hypertension and serum calcium (Ca) (95% CI: 1.242-28.080, P=0.026; 95% CI: 1.714-277.584, P=0.018); LVEF was correlated positively with lumbar vertebrae BMD (95% CI: 0.000 1-0.005 5, P=0.041); Left ventricular diastolic dysfunction was correlated positively with age, diabetes and parathyroid hyperplasia/nodules (95% CI: 1.050-1.176, P<0.001; 95% CI: 2.118-43.813, P=0.003 and 95% CI: 1.419-9.103, P=0.007); High CAC score was correlated positively with recipient age and dialysis time (95% CI: 1.036-1.160, P=0.001; 95% CI: 1.009-1.041, P=0.002); High TAC score was correlated positively with age (95% CI: 1.095-1.215, P<0.001). Correlation analysis indicated that TAC was correlated positively with serum Ca ( r=0.233, P=0.003), bone-specific alkaline phosphatase (BALP)( r=0.325, P<0.001) and type Ⅰ collagen cross-linked N-terminal peptide (NTX)( r=0.204, P=0.011) and negatively with femoral neck BMD ( r=0.194, P=0.017). Conclusions:There is a high prevalence of left ventricular structural and functional abnormalities and vascular calcification. It is closely correlated with mineral and bone disorders.