Objective:To investigate the onset time distribution and influential factors in patients with acute myocardial infarction (ACI) with different body mass index (BMI) levels.Methods:A cross-sectional study was conducted to collect clinical data from 1 000 patients with AMI who received treatment at Heilongjiang Provincial Hospital from January 2016 to November 2022. The patients were divided into groups based on different BMI levels: < 18.5 kg/m 2 group ( n = 49), 18.5-24 kg/m 2 group ( n = 369), > 24-28 kg/m 2 group ( n = 338), and > 28 kg/m 2 group ( n = 244). The incidence of AMI was analyzed among patients with different BMI levels as per diurnal variation, seasonality, and weekday. Results:A total of 1 000 patients were included in this study, including 648 men and 352 women. The mean age of these patients was 65 years (range 56-74 years). The median body mass was 70 kg (range 60-76 kg), the median height was 1.69 m (range 1.60-1.72 m), and the median BMI was 24.49 kg/m 2 (range 22.22-26.79 kg/m 2). The onset time of AMI differed significantly among patients with different BMI levels in terms of the period from 0:00 to 5:59, winter, and Wednesday ( P = 0.047, 0.029, 0.005). Among all samples, the number of patients with a BMI of 18.5-24 kg/m 2 was the highest, reaching 369 cases. Conclusion:The incidence of AMI in patients with different BMI levels exhibits a regular distribution as per diurnal variation, seasonality, and weekday.

Ceftazidime-avibactam （CAZ/AVI）is a novel β-lactam antibiotic with broad-spectrum antibacterial activity and good tolerability. However， the physiological and pathological differences in special populations [e.g. augmented renal clearance （ARC） patients， undergoing continuous renal replacement therapy （CRRT） patients， neonates and children， obese patients， undergoing extracorporeal membrane oxygenation （ECMO） patients， elderly patients and liver dysfunction patients] may affect the pharmacokinetic （PK） properties of CAZ/AVI， leading to treatment failure. At present， there is currently a lack of corresponding guidelines or consensus on dose adjustment of CAZ/AVI in special populations. This article summarizes the research on PK/ pharmacodynamic （PD） characteristics and dose adjustment of CAZ/AVI in special populations and recommends the following dosing regimens： for ARC patients， the recommended dose is 2.5 g， q8 h； for undergoing CRRT patients with infections caused by sensitive strains （i.e. MIC＜4 mg/L） and infections at sites where hydrophilic antibiotics distribute well， a dose of 1.25 g， q8 h may be used； for undergoing CRRT patients with less sensitive strains or sites with poorer drug distribution， a dose of 2.5 g， q8 h or continuous infusion may be considered； for children aged 6 months to ＜18 years with normal or mildly impaired renal function， a dose of 62.5 mg/kg， q8 h is infused for 2 h （maximum dose not exceeding 2.5 g per dose）； for infants aged 3～6 months with normal or mildly impaired renal function， a dose of 50 mg/kg， q8 h is infused for 2 h； for obese patients， the recommended dose is 2.5 g， q8 h， with therapeutic drug monitoring recommended；undergoing ECMO patients， elderly patients， and those with impaired liver function may also use the recommended dose of 179368757@qq.com 2.5 g， q8 h.

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.

Chronic mountain sickness (CMS) or Monge syndrome is a disease that is prevalent at altitude above 2 500 meters. High altitude polycythemia (HAPC) is one subtype of CMS. EPAS1 and EGNL1 are the most critical high-altitude adaptation genes in the genome of the Tibetan population. The HIF-PHD-VHL system plays an important role in the pathogenesis of HAPC. The protease encoded by the SENP1 gene regulates hypoxia related transcription factors such as HIF and GATA to affect the expression of EPO or EPOR involved in red blood cell generation. With the development of genetic testing and omics technology, new progress in the fields of metabolomics, proteomics and metabolomics has been made in the pathogenesis of HAPC. The above new research results provide a preliminary basis for bone marrow hematoecology and hematopoietic regulation of HAPC. The diagnostic criteria for CMS have certain limitations, especially in patients with excessive erythrocytosis who should undergo genetic testing recommended for congenital and polycythemia vera. This article provides a review of the latest research on HAPC in various omics techniques, hematopoietic regulation and diagnostic processes which is more conducive to understand the pathogenesis. The clinical diagnosis of excessive erythrocytosis emphasizes the importance of genetic testing.

Objective To evaluate the clinical application value of transcatheter arterial methylene blue angiography in the localization of lower gastrointestinal arterial bleeding.Methods Ten patients with lower gastrointestinal arterial bleeding received interventional celiac artery angiography.After the bleeding responsible arteries were identified,a microcatheter was super-selectively placed in the bleeding responsible artery.During surgical procedure,the methylene blue solution was injected through the microcatheter to display the bleeding segment of the intestinal tract,providing precise localization of the bleeding intestinal segment for surgical resection.Results Transcatheter arterial methylene blue angiography could clearly display the bleeding segment of the intestinal tract.The bleeding segments of the intestinal tract in the 10 patients were quickly and accurately removed.After surgery,the gastrointestinal bleeding stopped,and no surgery-related complications occurred.Conclusion Transcatheter arterial methylene blue angiography can accurately detect the arterial bleeding segment of the lower gastrointestinal tract,which provides precise localization for quickly removing the bleeding segment of intestinal tract,therefor,this technique is worthy of widespread clinical application.(J Intervent Radiol,2023,32:1230-1232)

Objective:To investigate the application value of donor liver autologous portal venous blood rinse in orthotopic liver transplantation (OLT).Methods:The retrospective cohort study was conducted. The clinicopathological data of 35 pairs of donors and recipients who underwent OLT in the First Affiliated Hospital of University of Science and Technology of China from May 2018 to June 2019 were collected. Of the 35 donors, there were 31 males and 4 females, aged (48±9)years. Of the 35 recipients, there were 25 males and 10 females, aged (47±9)years. Of the 35 recipients, 16 recipients undergoing donor liver autologous portal venous blood rinse were allocated into the portal vein group, and 19 recipients undergoing donor liver albumin water rinse were allocated into the albumin group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data of skewed distribution were represented as M(range). Count data were descried as absolute numbers, and comparison between groups was analyzed using the Fisher exact probability. Results:(1) Surgical situations. The anhepatic phase time and arterial blood Ca 2+ concentration within 5 minutes after reperfusion of the recipients were (52±12)minutes and (0.99±0.10)mmol/L in the portal vein group, versus (64±12)minutes and (1.05±0.07)mmol/L in the albumin group, showing significant differences in the above indicators between the two groups ( t=2.94, 2.22, P<0.05). The mean arterial pressure, arterial blood K +concentration and arterial blood pH within 5 minutes after reperfusion of the recipients were (70±24)mmHg (1 mmHg=0.133 kPa), (4.7±1.3)mmol/L and 7.27±0.06 in the portal vein group, versus (71±28)mmHg, (4.6±1.1)mmol/L and 7.30±0.07 in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.14, 0.30, 1.22, P>0.05). (2) Post-operative situations. Cases with post-reperfusion syndrome (PRS), cases with severe PRS of cardiac arrest, cases with primary graft nonfunction of the recipients were 6, 0, 2 in the portal vein group, versus 8, 1, 1 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). Total bilirubin on postoperative day 7 of the recipients was (90±52)μmol/L in the portal vein group, versus (166±112)μmol/L in the albumin group, showing a significant difference between the two groups ( t=2.66, P<0.05). International normalized ratio on postoperative day 7, the highest alanine aminotransferase and aspartate aminotransferase within 7 days after operation of the recipients were 2.1±2.0, (1 952±2 813)IU/L and (3 944±6 673)IU/L in the portal vein group, versus 1.8±0.6, (1 023±1 014) IU/L and (2 005±2 910)IU/L in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.66, 1.23, 1.08, P>0.05). Recipients with hepatic artery complication and biliary complication were 1 and 2 in the portal vein group, versus 0 and 4 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). There were 3 cases and 2 cases died during the perioperative period in the portal vein group and the albumin group, respectively. (3) Follow-up. Of the 35 recipients, 30 recipients were followed up for 534(range, 28?776)days after operation. During the follow-up, there were 3 patients with postoperative complications in the portal vein group including 2 cases died and 1 case recovered after sympto-matic treatment. There were 5 patients with postoperative complications in the albumin group including 1 case died and 4 cases recovered after symptomatic treatment. Up to the follow-up date, 11 patients in the portal vein group and 16 patients in the albumin group were in good condition. Conclusion:Rinse of the donor liver with autologous portal venous blood during liver transplantation can shorten the time of anhepatic phase, without increasing the occurrence of post-reperfusion syndrome, ischemia re-perfusion injury and biliary tract complications.

Knee osteoarthritis （KOA） is a common degenerative joint disease in the middle-aged and elderly. The incidence of KOA is rising as the population aging aggravates and the obese population grows. KOA seriously affects the health and daily life of the patients. The commonly used drugs for the symptomatic treatment of KOA include non-steroidal anti-inflammatory drugs， cartilage protective drugs， and opioid analgesics， which have limited therapeutic effects and induce obvious adverse drug reactions. Eucommiae Cortex is one of the commonly used Chinese herbal medicines for the treatment of KOA， while its pharmacological material basis and mechanism remain unclear， which limits its clinical application. The active ingredients of Eucommiae Cortex for treating KOA mainly include iridoids （geniposide， aucubin）， lignans （pinoresinol diglucoside）， flavonoids （quercetin， astragaloside， baicalein， hyperoside， and kaempferol）， phenylpropanoids （chlorogenic acid）， and polysaccharides. These compounds regulate the levels of inflammatory cytokines， inhibit oxidative stress， protect chondrocytes， balance the synthesis and degradation of extracellular matrix， and control the progression of KOA via the mitogen-activated protein kinase， nuclear factor-κB， phosphatidylinositol-3-kinase/protein kinase B， and Janus kinase 1/signal transducer and activator of transcription 3 signaling pathways. This paper introduces the mechanisms of Eucommiae Cortex and its active components in the treatment of KOA， aiming to provide a theoretical basis for the development of new drugs for KOA.

Objective:To compare the long-term prognosis between open versus closed reduction and internal fixation in the treatment of unstable pelvic fractures.Methods:The data of 402 consecutive patients with unstable pelvic fracture were retrospectively analyzed who had been treated at The First Medical Center and The Fourth Medical Center, PLA General Hospital, and Strategic Support Force Specialty Medical Center from March 2011 to March 2017. This cohort was divided into 2 groups according to the reduction methods. In the open group of 194 cases subjected to open reduction and internal fixation, there were 133 males and 61 females with a median age of 43.0 (30.7, 51.0) years, and 35 cases of type B and 159 cases of type C by the Tile classification. In the closed group of 208 cases subjected to closed reduction and internal fixation, there were 115 males and 93 females with a median age of 45.5 (32.0, 56.0) years, and 40 cases of type B and 168 cases of type C by the Tile classification. The 2 groups were compared in terms of 12-items Short Form Health Survey (SF-12) scores [physical component summary (PCS) and mental component summary (MCS)] at the last follow-up, time from injury to operation, frequency of intraoperative X-ray fluoroscopy, intraoperative and postoperative blood transfusion, operation time, and quality of postoperative fracture reduction.Results:There was no statistically significant difference between the 2 groups in the preoperative general data except for the gender, showing the 2 groups were comparable ( P>0.05). This cohort of 402 patients was followed up for 7.8(6.2, 8.8) years. At the last follow-up, the PCS [49.9 (45.4, 55.4) points] and MCS [53.1 (46.4, 57.6) points] in the closed group were significantly higher than those in the open group [48.2 (41.4, 52.7) and 46.5 (40.6, 53.6) points] ( P<0.05). The closed group incurred significantly shorter time from injury to operation [6 (5, 8) d] and operation time [180 (126, 260) min] than the open group [9 (6, 13) d and 240 (165, 334) min], significantly less intraoperative and postoperative blood transfusion [1.5 (0, 4.0) U] than the open group [5.0 (2.9, 8.0) U], significantly higher frequency of intraoperative X-ray fluoroscopy [104.5 (85.0, 132.0) times] than the open group [21.0 (18.0, 26.0) times], and a significantly higher excellent and good rate of postoperative fracture reduction (92.8%, 193/208) than the open group (86.6%, 168/194) (all P<0.05). Conclusion:In the treatment of patients with unstable pelvic fractures, compared with open reduction and internal fixation, closed reduction and internal fixation can not only significantly shorten the waiting time and operation time of patients, reduce the transfusion during operation, but also achieve better fracture reduction to ultimately improve the quality of life of patients.

As a prescription for tonifying kidney yang， Youguiwan accords with the pathogenesis of osteoarthritis. Professor LIU Yuan-lu from the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine found that modified Youguiwan had a significant effect on the clinical conservative treatment of osteoarthritis pain with Chinese medicine. There are teams studying the mechanism of Youguiwan in the treatment of osteoarthritis in China， but the profound study of the compound needs the mechanism of each component as support. Youguiwan contains 10 kinds of Chinese medicine， including Rehmanniae Radix Praeparata， Aconiti Lateralis Radix Praeparata， Cinnamomi Cortex， Dioscoreae Rhizoma， Corni Fructus， Cuscutae Semen， Angelicae Sinensis Radix， Eucommiae Cortex， Cervi Cornus Colla， and Lycii Fructus. With more and more attention to the study of Chinese medicine monomer， the amount of related research in this field is increasing. Therefore， it is of great significance to summarize the mechanism of Youguiwan in the treatment of osteoarthritis. Based on the sovereign， minister， assistant， and guide of Chinese medicine in Youguiwan， this paper used China National Knowledge Infrastructure （CNKI）， Pharmacopoeia of the People's Republic of China （2020 edition Vol. 1）， and ChemicalBook platform to understand the active components of each kind of Chinese medicine， and used PubMed to search. The latest research progress of effective monomers that had an intersection with the mechanism of osteoarthritis was summarized， and there were five pharmacological effects including anti-inflammation， pain inhibition， chondrocyte apoptosis， oxidative stress， and extracellular matrix degradation， involving several signaling pathways. The theory of sovereign， minister， assistant， and guide and the molecular mechanism were integrated and discussed， respectively， and finally， they were combined with traditional Chinese medicine theory， providing theoretical references for further study in this direction.

OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.