Objective: To explore the clinical features, treatment and prognosis of emphysematous pyelonephritis (EPN), so as to enhance the clinical awareness of this disease. Methods: A retrospective analysis was conducted on the clinical data of one EPN patient at The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, and a literature review was performed on articles published in the China National Knowledge Infrastructure and PubMed databases from Jan.1, 2015 to Dec.31, 2024. Results: The patient, a 62-year-old male with a 5 years' history of type 2 diabetes, was admitted due to left flank pain for 4 days, with a temperature of 39.4 ℃.Laboratory tests indicated significantly elevated inflammatory markers, decreased platelet count, and abnormal coagulation function.Preoperative blood and urine cultures showed positivity for Escherichia coli.Computed tomography (CT) revealed complete erosion of the left kidney, with gas in the left ureter and surrounding effusion, as well as multiple free gas in the abdominal cavity, bilateral ureteral stones, right renal lower calyx stones.After a multidisciplinary consultation, he underwent emergency phase Ⅰ left pyeloplasty and perirenal drainage with ureteral stenting.After discharge, the patient received maintenance hemodialysis once every two days in the outpatient clinic.One week after-discharge, the patient was readmitted due to polypnea.Following symptomatic management, vital signs stabilized.Approximately 2 months after the first-stage surgery, ureteroscopic stone extraction was successfully performed.One month after the stone extraction procedure, a follow-up CT showed normalization of the left kidney, renal pelvis and calyces, leading to phase Ⅱ laparoscopic left nephrectomy via the abdominal approach, with postoperative pathology indicating renal necrosis.Among 89 EPN patients reported in 35 articles, the median age was 58(24-92) years old；there were 59（66.3%） females and 30（33.7%） males；fever was the most common clinical symptom (60.7%)；73(82.0%) had diabetes, 12 (13.5%) had urinary tract obstruction；55 (61.8%) were infected with Escherichia coli, and 7 (7.9%) were infected with Klebsiella pneumoniae; 13 died due to ineffective treatmen. Conclusion: EPN presents acutely and progresses rapidly, often leading to misdiagnosis due to the lack of specific early symptoms.Abdominal CT is the preferred imaging modality for rapid diagnosis, and proactive interdisciplinary intervention can improve survival rates, reduce the need for nephrectomy, and enhance prognosis.

Objective:To compare the surgical efficacy of pericardial soft ring tricuspid valvuloplasty with DeVega and artificial valvuloplasty.Methods:227 patients undergoing tricuspid valvuloplasty due to rheumatic heart disease complicated with functional tricuspid valve insufficiency were retrospectively analyzed and divided into 3 groups according to tricuspid valvuloplasty dynamic cohort(pericardial ring group, 89 cases; the artificial flap ring group, 61 cases, and the DeVega group, 77 cases) were matched 1∶1 for propensity score(match A: pericardial ring group and artificial flap ring group; match B: pericardial ring group and DeVega group), the successful matching was included in follow-up and data collection, and cases with incomplete case data during follow-up were removed from the study cohort in pairs according to matching conditions. The results of follow-up 1 month, 6 months and 24 months after surgery were compared.Results:1 month after operation: the tricuspid valve regurgitant in all groups was significantly reduced or even disappeared compared with that before operation, and the right atrium and right ventricle were also smaller than that before operation, with statistical significance( P<0.05). 6 months after surgery: There was no statistical significance in the area of tricuspid regurgitation and right atrial/indoor diameter between all groups compared with the results one month after surgery( P>0.05), and there was no statistical significance in the recurrence rate of tricuspid regurgitation between all groups( P>0.05). 24 months after surgery: There were no significant differences in the recurrence rate of tricuspid regurgitation, area of tricuspid regurgitation and right atrial/indoor diameter between the two groups in matching A( P>0.05). There was no statistical significance in the right atrial/indoor diameter between the matched pericardial ring group and the Devega group, but the tricuspid valve regurgentation area of the Devega group at 24 months after surgery was higher than that of the Devega group at 1 month after surgery, and the difference was statistically significant( P<0.05). The regurgitation area and recurrence rate of tricuspid valve were significantly higher than those of pericardium-TVP group( P<0.05). Conclusion:Pericardial soft ring tricuspid valvuloplasty can effectively correct functional tricuspid valvuloplasty and reverse right heart remodeling, which is an effective tricuspid valvuloplasty.

OBJECTIVE To investigate the effect of Guanxinning tablets(GXN) on early heart failure model rats, and to explore the protective mechanism of GXN on heart failure rats from the perspective of intestinal flora. METHODS Six rats who underwent sham operation were set as sham operation group. Took 80 SD rats to undergo aortic arch stenosis and established a heart failure rat model. The surviving rats were divided into 4 groups, namely the model control group, the positive control group(captopril tablets 12.5 mg·kg–1), high-dose and low-dose of GXN group(600, 1 200 mg·kg–1). The 4 groups were administered continuously for 8 weeks. Cardiac ultrasonography was performed every 4 week. Serum NT-proBNP, hs-CRP, IL-6, TNF-α, SOD and MDA levels were measured. The effects of GXN on the structure and function of intestinal flora were observed based on the high-throughput sequencing technology and bioinformatics analysis of 16S gut microbiome. RESULTS Compared to the model control group, after giving different doses of GXN, the survival rate of rats increased, and the thickness of the ventricular wall decreased to varying degrees. The weight of the heart and coefficient of the heart were all reduced. GXN could also reduce the level of inflammatory factors, inhibit the level increase of NT-proBNP in rats, and increase the activity of serum SOD. In addition, GXN intervention could significantly improve the intestinal flora diversity of rats with heart failure, the possible target genera of GXN were Akkermansia genera, Phascolarctobacterium genera and Oxalobacter genera. The effect of GXN on intestinal function in rats with heart failure might be concentrated in non-homologous end-joining, influenza A, carotenoid synthesis, indole alkaloids biosynthesis, betalain biosynthesis, renin-angiotensin system and other biological pathways. CONCLUSION The protective effect of GXN on early heart failure rats may be related to the regulation of intestinal flora pathway.

Internal carotid artery occlusion(ICAO)is not a rare finding in clinical practice.Most studies have indicated that the recanalization of ICAO can reduce the incidence of stroke and improve patient's cognition.However,because of its high surgical difficulty,low success rate and more complications,it seriously affects the prognosis of patients,which is the key and difficult point in the field of cerebrovascular interventional therapy at present.This paper briefly reviews the concept of ICAO non-acute phase recanalization,preoperative imaging evaluation,current treatment status,and common perioperative complications,etc.(J Intervent Radiol,2024,33:571-575)

【Objective】 To establish a practical and feasible blood management (PBM) model for clinical liver transplant patients, so as to optimize the perioperative blood usage and improve patient prognosis and survival rate. 【Methods】 Led by the Medical Department, a questionnaire survey Establishment and Implementation of a Blood Management Model for Organ Transplant Patients on the importance of establishing a PBM model for liver transplant patients in clinical practice was conducted among 71 staff from relevant departments such as the Anesthesiology Department, Hepatobiliary Department, Blood Transfusion Department, and ICU Medical Department. After statistical analysis, the important items of PBM for liver transplant patients were determined, and a (trial) plan was organized by the Medical Department and training was conducted by Blood Transfusion Department for medical staff training from departments as Anesthesiology, Hepatobiliary and Pancreatology, and ICU; PBM measures for liver transplant patients before, during and after surgery were determined by the Anesthesiology Department, Hepatobiliary and Pancreatic Department, and ICU; PBM was fully implemented in the experimental group with liver transplant patients in our hospital in 2021 as subjects; 30 cases of liver transplantation performed in our hospital in 2020 were selected as the control group, and the general data, preoperative laboratory examination results, and preoperative, intraoperative, and postoperative blood transfusion of the two groups of patients were compared. 【Results】 Compared with the control group, the experimental group did not receive any blood component transfusion before surgery. Intraoperative blood transfusion volume of allogeneic components: red blood cells(U) were 12.75(8.75, 18.63) vs 15.25(8.38, 26.13)(P>0.05), apheresis platelet (treatment volume) was 0(0, 2) vs 1(0, 4.25)(P>0.05), plasma(U) was 2 300(1 550, 3 763) vs 3 650(2 075, 5 400)(P<0.05); cryoprecipitate(U) was 0(0, 10) vs 10(0, 30)(P<0.05); Postoperative blood transfusion volume of allogeneic components were as follows: red blood cells(U) 8.00(3.38, 12.88) vs 11.25(4.75, 19.63)(P>0.05), platelets were not transfused, plasma(U) was 0(0, 0) vs 0(0, 600)(P>0.05), and cryoprecipitates were not transfused. 【Conclusion】 The establishment of PBM model for liver transplant patients and the application of its management measures before, during and after transplantation significantly reduced the intraoperative blood transfusion volume and improved the prognosis of patients after transplantation.

ObjectiveTo analyze the mental health status and its influencing factors in middle school students under the regular prevention and control of COVID-19， so as to provide references for the intervention and management of their mental health problems. MethodsFrom March 7 to 21， 2021， a stratified random sampling method was used to select 19 352 students from 17 schools in 3 districts and 9 counties of Linyi City， Shandong Province. Basic data were collected through a self-designed questionnaire. All students completed the Symptom Checklist 90 （SCL-90） to assess their mental health status. Then the factors affecting the mental health status of middle school students were screened using independent sample t-test， one-way ANOVA test and multiple stepwise regression analysis. Results① A total of 6 350 （32.81%） middle school students were found to have mental health problems. ② Each SCL-90 factor score and total average score yielded statistical difference among middle school students of different genders， relationships with classmate， closeness to friends， concerns about the epidemic， and pressure exerted by schoolwork （P<0.01）. Each SCL-90 factor score and total average score of middle school students were significant different in terms of the hours of smartphone usage for recreation per day， sleep duration per night in hours and exercise frequency （P<0.01）. ③ Multiple stepwise regression analysis denoted that female gender， poor relationship with classmate， no close friend and long hours of smartphone usage for recreation were the risk factors for mental health of middle school students （β=0.096， 0.183， 0.064， 0.232， P<0.01）. ConclusionThe prevalence rate of mild mental health problems is quite high among middle school students under the regular epidemic prevention and control. Additionally， female gender， poor relationship with classmate， no close friend and long hours of smartphone usage for recreation have a negative impact on middle school students' mental health.

Objective:To investigate the effects of intravenous thrombolysis combined with Xingnaojing injection on hemodynamic indexes and neurological function in patients with cerebral infarction. Methods:A total of 142 patients with cerebral infarction who were treated in Xing An Meng Hospital from April 2020 to May 2021 were included in this study. They were randomly divided into a control group ( n = 71, intravenous thrombolysis) and a Xingnaojing injection group ( n = 71, intravenous thrombolysis + Xingnaojing injection). Intracranial arterial hemodynamic indexes, National Institutes of Health Stroke Scale score, Fugl-Meyer Assessment Scale score, serum inflammatory factors, oxidative stress indexes, brain injury markers, and the incidence of adverse reactions were compared between the two groups. Results:After treatment, serum levels of interleukin-1β, interleukin-6, and tumor necrosis factor-α were significantly lower in the Xingnaojing injection group than the control group [interleukin-1β: (4.05 ± 0.83) ng/L vs. (6.85 ± 1.02) ng/L, interleukin-6: (43.61 ± 5.14) ng/L vs. (60.31 ± 7.04) ng/L, tumor necrosis factor-α: (35.93 ± 4.25) ng/L vs. (20.93 ± 3.11) ng/L, t = 17.94, 16.14, 15.37, all P < 0.001]. After treatment, the mean blood flow velocities of the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery in the Xingnaojing injection group were significantly higher than those in the control group [anterior cerebral artery: (49.36 ± 5.28) cm/s vs. (41.15 ± 5.12) cm/s, middle cerebral artery: (61.27 ± 7.02) cm/s vs. (50.19 ± 6.08) cm/s, posterior cerebral artery: (44.92 ± 5.63) cm/s vs. (37.26 ± 4.93) cm/s, t = 9.40, 10.05, 8.62, all P < 0.001]. After treatment, the National Institutes of Health Stroke Scale score and Fugl-Meyer Assessment Scale score in the Xingnaojing injection group were superior to those in the control group [National Institutes of Health Stroke Scale score: (10.36 ± 1.52) points vs. (14.62 ± 2.05) points, Fugl-Meyer Assessment Scale score: (76.19 ± 8.08) points vs. (65.28 ± 7.14) points, t = 14.06, 8.52, both P < 0.05]. After treatment, the serum level of malondialdehyde in the Xingnaojing injection group was significantly higher than that in the control group [(6.35 ± 1.02) μmol/L vs. (10.05 ± 1.63) μmol/L), t = 16.21, P < 0.001]. The serum level of superoxide dismutase in the Xingnaojing injection group was significantly lower than that in the control group [(114.31 ± 13.69) U/L vs. (92.25 ± 10.16) U/L), t = 10.90, P < 0.001]. Serum levels of neuron-specific enolase and S100β in the Xingnaojing injection group were significantly lower than those in the control group [neuron-specific enolase: (24.01 ± 3.24) IU/L vs. (30.31 ± 4.02) IU/L, S100β: (0.73 ± 0.17) ng/L vs. (1.13 ± 0.22) ng/L, t = 10.28, 12.12, both P < 0.001). There was a significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Intravenous thrombolysis combined with Xingnaojing injection for the treatment of cerebral infarction can improve intracranial hemodynamics, reduce the inflammatory response and oxidative stress, and alleviate brain tissue injury. The combined therapy is beneficial to protect the neurological function of patients with cerebral infarction and is highly safe.

Objective:Based on single-center clinical results of endovascular recanalization for symptomatic non-acute internal carotid artery occlusion (ICAO), a new patient classification method is proposed to distinguish the most suitable ICAO patient subgroups for endovascular recanalization.Methods:A total of 140 patients with symptomatic non-acute ICAO accepted endovascular recanalization in Department of Cerebrovascular Intervention, He'nan Provincial People's Hospital from January 2019 to December 2021 were selected. These patients were divided into low risk group ( n=57), medium risk group ( n=54) and high risk group ( n=29) according to the occlusion segments, occlusion times, plaque features, calcification at the occlusion site and occlusion segment angulation. The immediate postoperative recanalization rate, perioperative complications, perioperative death, and prognoses 90 d after endovascular recanalization (modified Rankin scale scores of 0-2 as good prognosis) were evaluated in the 3 groups. Results:The immediate postoperative recanalization rate was 82.9% (114/140), perioperative complication rate was 11.4% (16/140), and perioperative mortality was 0.7% (1/140). The success recanalization rate decreased gradually from the low risk group to the high risk group (100%, 85.2%, and 37.9%), while the perioperative complication rate was the opposite (0%, 11.1%, and 34.5%), with significant differences ( P<0.05). Ninety d after endovascular recanalization, 109 patients had good prognosis and 27 had poor prognosis; the good prognosis rate in low risk group, medium risk group and high risk group was 98.2%, 79.6% and 34.5%, respectively, with significant differences ( P<0.05). The vascular restenosis rate in low risk group, medium risk group and high risk group was 0%, 8.7% and 18.2%, and re-occlusion rate was 0%, 6.5% and 27.2%, respectively, 90 d after endovascular recanalization, with significant differences ( P<0.05). Conclusion:Endovascular recanalization is technically feasible for patients with symptomatic non-acute ICAO, especially those met the criterions of low and medium risk groups in our study.

Objective: To investigate the sleep status among primary and middle school students in Zhoushan City, Zhejiang Province, so as to provide insights into improving the sleep quality among primary and middle school students. Methods: A district and a county was selected using the cluster random sampling method from Zhoushan City in October, 2019, and grades 4 to 6 primary school students, junior high school and high school students were sampled as the study subjects. Students' gender, grade, residing in schools, duration of homework and duration of extracurricular classes were collected using the questionnaires of the 2019 national program for common diseases and health risk factors surveillance and intervention program among Chinese students. According to the Plan for the Comprehensive Prevention and Control of Myopia among Children and Adolescents, daily sleep duration of 10 h and longer among primary school students, 9 h and longer among junior high school students and 8 h and longer among high school students were defined as adequate sleep, and the proportion of adequate sleep was estimated among primary and middle school students. Results: Totally 3 042 students were enrolled, including 1 587 boys (52.17%) and 1 455 girls (47.83%), 996 primary school students (32.74%), 1 030 junior high school students (33.86%), 758 ordinary high school students (24.92%) and 258 vocational high school students (8.48%). The mean sleep duration was (9.23±1.10) h among primary school students, (8.09±1.05) h among junior high school students, (7.20±1.26) h among ordinary high school students and (7.97±1.03) h among vocational high school students, respectively, and the proportion of adequate sleep was 26.31% among primary school students, 22.82% among junior high school students, 22.56% among ordinary high school students and 66.67% among vocational high school students, respectively. A relatively higher proportion of adequate sleep was seen among primary school students in Grade 4 (33.63%) and with homework duration of less than 1 h (34.53%); among junior high school students in Grade 1 (37.76%), residing in schools (40.00%), studying in county schools (30.87%), with homework duration of less than 1 h (34.69%) and less than 1 h duration of extracurricular classes (33.33%); among male ordinary high school students (28.03%), and ordinary high school students in Grade 1 (28.30%), residing in schools (26.18%) and studying in district schools (25.83%); among male vocational high school students (69.06%) and vocational high school students residing in schools (73.14%). Conclusion The proportion of adequate sleep is low among primary and middle school students in Zhoushan City. The homework duration and duration of extracurricular classes are recommended to be reduced to ensure adequate sleep among primary and middle school students.

Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.