Vitamin D Plays a Crucial Role in Regulating Dopamine Nervous System in Brain / 生物化学与生物物理进展

Vitamin D is a unique fat-soluble vitamin that plays an indispensable role in human health. It exists in various forms, the most significant being vitamin D2 (derived from plant sources) and vitamin D3 (synthesized naturally in human skin upon exposure to sunlight). Vitamin D’s primary function is to facilitate the absorption of calcium and phosphorus, which are crucial for maintaining healthy bones. Beyond its role in bone health, vitamin D significantly influences the immune system, muscle function, cardiovascular health, and the regulation of brain functions. A deficiency in vitamin D can lead to various chronic diseases such as rickets, osteoporosis, decreased immunity, increased risk of mental disorders, and cancers. The synthesis of vitamin D in the human body, both peripherally and centrally, relies on sunlight exposure, dietary sources, and various supplements. As a neuroactive steroid, vitamin D impacts both the physiological and pathological processes of the nervous system and plays a key role in brain health. It profoundly affects the brain by regulating neurotransmitter synthesis and maintaining intracellular calcium balance. As an essential chemical molecule, vitamin D participates in complex signal transduction pathways, impacting neurotransmitter functions and synaptic plasticity. Vitamin D’s role in regulating dopamine (DA)—a neurotransmitter critical for motivation, reward perception, and other higher cognitive functions—is particularly noteworthy. Recent studies have revealed that vitamin D not only promotes the synthesis of DA but also plays a role in regulating DA levels within the brain. It exerts neuroprotective effects on DA neurons through anti-inflammatory, antioxidant actions, and neurotrophic support, thereby creating an optimal environment for DA neurons, influencing neuronal structure, and affecting the movement of calcium ions within nerve cells, positively impacting the overall health and functionality of the DA system. Furthermore, vitamin D can regulate the synthesis and release of DA, thus affecting the signal transmission of various DA neural projection pathways in the brain. This function is vital for understanding the complex interactions between neural mechanisms and their effects on key behaviors and cognitive functions. This review aims to delve deeply into the synthesis, metabolism, and pathways of vitamin D’s action, especially its regulatory mechanisms on DA neurons. Through this exploration, this article seeks to provide a solid theoretical foundation and research framework for a deeper understanding of vitamin D’s role in motivation and reward behaviors. This understanding is crucial for appreciating the broader significance of vitamin D in the fields of neuroscience and neurology. In summary, research and discoveries regarding vitamin D’s impact on the nervous system highlight its importance in neural health and function. These insights not only enhance our understanding of the complex workings of the nervous system but also open new avenues for the prevention and treatment of neurological diseases. The exploration of vitamin D’s multifaceted roles offers promising prospects for developing new therapeutic strategies, underscoring the compound’s potential in addressing a range of neural dysfunctions and diseases. As research continues to evolve, the profound implications of vitamin D in the field of neurology and beyond become increasingly apparent, marking it as a key target for ongoing and future scientific inquiry.

Phase Separation of Biomacromolecules and Its Important Role in Transcriptional Regulation / 生物化学与生物物理进展

Cells not only contain membrane-bound organelles (MBOs), but also membraneless organelles (MLOs) formed by condensation of many biomacromolecules. Examples include RNA-protein granules such as nucleoli and PML nuclear bodies (PML-NBs) in the nucleus, as well as stress granules and P-bodies in the cytoplasm. Phase separation is the basic organizing principle of the form of the condensates or membraneless organelles (MLOs) of biomacromolecules including proteins and nucleic acids. In particular, liquid-liquid phase separation (LLPS) compartmentalises and concentrates biological macromolecules into liquid condensates. It has been found that phase separation of biomacromolecules requires some typical intrinsic characteristics, such as intrinsically disordered regions, modular domains and multivalent interactions. The phase separation of biomacromolecules plays a key role in many important cell activities. In recent years, the phase separation of biomacromolecules phase has become a focus of research in gene transcriptional regulation. Transcriptional regulatory elements such as RNA polymerases, transcription factors (TFs), and super enhancers (SEs) all play important roles through phase separation. Our group has previously reported for the first time that long-term inactivation or absence of assembly factors leads to the formation of condensates of RNA polymerase II (RNAPII) subunits in the cytoplasm, and this process is reversible, suggesting a novel regulatory model of eukaryotic transcription machinery. The phase separation of biomacromolecules provides a biophysical understanding for the rapid transmission of transcriptional signals by a large number of TFs. Moreover, phase separation during transcriptional regulation is closely related to the occurrence of cancer. For example, the activation of oncogenes is usually associated with the formation of phase separation condensates at the SEs. In this review, the intrinsic characteristics of the formation of biomacromolecules phase separation and the important role of phase separation in transcriptional regulation are reviewed, which will provide reference for understanding basic cell activities and gene regulation in cancer.

The Progression of Postmortem Biochemistry Analysis in Forensic Discrimination of Cause of Death / 中山大学学报(医学科学版)

The discrimination of the cause of death is an important part in forensic medicine. With the advantages of simple operation， high test efficiency， and easy sensitivity to the death mechanism of the deceased， postmortem biochemistry analysis has become a significant auxiliary analysis method for discrimination of the cause of death. In this paper， we discuss the development status， advantages and current problems of postmortem biochemical analysis， and then describe the application prospect of postmortem biochemistry in the discrimination of the cause of death by posing feasible solutions， so that to provide an idea for this research.

Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation / 中华医学杂志(英文版)

BACKGROUND@#Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.@*METHODS@#Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed.@*RESULTS@#A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P  <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P  <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001).@*CONCLUSIONS@#In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.

The association between body mass index and in-hospital major adverse cardiovascular and cerebral events in patients with acute coronary syndrome / 中华心血管病杂志

Objective: To assess the association between body mass index (BMI) and major adverse cardiovascular and cerebrovascular events (MACCE) among patients with acute coronary syndrome (ACS). Methods: This was a multicenter prospective cohort study, which was based on the Improving Care for Cardiovascular Disease in China (CCC) project. The hospitalized patients with ACS aged between 18 and 80 years, registered in CCC project from November 1, 2014 to December 31, 2019 were included. The included patients were categorized into four groups based on their BMI at the time of admission: underweight (BMI<18.5 kg/m2), normal weight (BMI between 18.5 and 24.9 kg/m2), overweight (BMI between 25.0 and 29.9 kg/m2), and obese (BMI≥30.0 kg/m2). Multivariate logistic regression models was used to analyze the relationship between BMI and the risk of in-hospital MACCE. Results: A total of 71 681 ACS inpatients were included in the study. The age was (63.4±14.7) years, and 26.5% (18 979/71 681) were female. And the incidence of MACCE for the underweight, normal weight, overweight, and obese groups were 14.9% (322/2 154), 9.5% (3 997/41 960), 7.9% (1 908/24 140) and 7.0% (240/3 427), respectively (P<0.001). Multivariate logistic regression analysis showed a higher incidence of MACCE in the underweight group compared to the normal weight group (OR=1.30, 95%CI 1.13-1.49, P<0.001), while the overweight and obese groups exhibited no statistically significant difference in the incidence of MACCE compared to the normal weight group (both P>0.05). Conclusion: ACS patients with BMI below normal have a higher risk of in-hospital MACCE, suggesting that BMI may be an indicator for evaluating short-term prognosis in ACS patients.

The association between body mass index and in-hospital major adverse cardiovascular and cerebral events in patients with acute coronary syndrome / 中华心血管病杂志

Objective: To assess the association between body mass index (BMI) and major adverse cardiovascular and cerebrovascular events (MACCE) among patients with acute coronary syndrome (ACS). Methods: This was a multicenter prospective cohort study, which was based on the Improving Care for Cardiovascular Disease in China (CCC) project. The hospitalized patients with ACS aged between 18 and 80 years, registered in CCC project from November 1, 2014 to December 31, 2019 were included. The included patients were categorized into four groups based on their BMI at the time of admission: underweight (BMI<18.5 kg/m2), normal weight (BMI between 18.5 and 24.9 kg/m2), overweight (BMI between 25.0 and 29.9 kg/m2), and obese (BMI≥30.0 kg/m2). Multivariate logistic regression models was used to analyze the relationship between BMI and the risk of in-hospital MACCE. Results: A total of 71 681 ACS inpatients were included in the study. The age was (63.4±14.7) years, and 26.5% (18 979/71 681) were female. And the incidence of MACCE for the underweight, normal weight, overweight, and obese groups were 14.9% (322/2 154), 9.5% (3 997/41 960), 7.9% (1 908/24 140) and 7.0% (240/3 427), respectively (P<0.001). Multivariate logistic regression analysis showed a higher incidence of MACCE in the underweight group compared to the normal weight group (OR=1.30, 95%CI 1.13-1.49, P<0.001), while the overweight and obese groups exhibited no statistically significant difference in the incidence of MACCE compared to the normal weight group (both P>0.05). Conclusion: ACS patients with BMI below normal have a higher risk of in-hospital MACCE, suggesting that BMI may be an indicator for evaluating short-term prognosis in ACS patients.

Macrophage-to-myofibroblast transition promotes pulmonary fibrosis occurred in LPS-induced acute lung injury of mouse models / 基础医学与临床

Objective To explore the impact of macrophage-to-myofibroblast transition(MMT)on pulmonary fibro-sis induced by acute lung injury by LPS.Methods Totally 21 male mice were randomly classified into 7 groups:control group,model group(LPS-PF)at different time points and intervention group of clodronate-liposomes(CL-LIP)treatement at different time points(n=3).Pulmonary fibrosis was identified by HE and Masson staining microscopy.The immuno-fluorescence technology was used for the evaluation of numbers of macrophage-to-myofi-broblast transition cells(MMT cell which co-expressed CD68 and α-SMA).Bone marrow-derived macrophages(BMDMs)were randomly classified into two group:control(Ctrl)group and TGF-β1-treated group induced by transforming growthfactor-β1.α-SMA,FN and Col1 were detected by RT-qPCR.The expression of α-SMA,Smad3 and p-Smad3 protein was evaluated by Western blot.Results At day 7,the Ashcroft score of lung tissue in LPS-PF mouse model was significantly increased when compared with the Ctrl group(P＜0.01);While the score signifi-cantly declined when the model was pretreated with CL-LIP(P＜0.05).As detected by immuno-fluorescence stai-ning,in CL-LIP group the number of CD68-positive cells co-labeled with α-SMA was obviously less then that of LPS-PF group of the corresponding time point(P＜0.01).When the BMDMs were stimulated by TGF-β1 at 24 h,48 h and 96 h respectively,a higher expression of α-SMA,FN,Col1,were found in TGF-β1-treated group than that in Ctrl group at the corresponding time point(P＜0.01).The expression of Smad3,p-Smad3 significantly higher in LPS-PF group(at both day 7 and day 10)and TGF-β1-treated group(at both 48 h and 96 h)as compared to cor-responding control group(P＜0.01).Conclusions MMT promotes pulmonary fibrosis induced by ALI via LPS.Smad3 is proved to be involved in the MMT process.

Pathological evaluation of endoscopic submucosal dissection for early gastric cancer and precancerous lesion in 411 cases / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the pathological characteristics of endoscopic submucosal dissection (ESD) specimens for early gastric cancer and precancerous lesions, accumulating experience for clinical management and pathological analysis.@*METHODS@#A total of 411 cases of early gastric cancer or precancerous lesions underwent ESD. According to the Japanese guidelines for ESD treatment of early gastric cancer and classification of gastric carcinoma, the clinicopathological data, pathologic evaluation, concordance rate of pathological diagnosis between preoperative endoscopic forceps biopsies and their ESD specimens (in 400 cases), as well as the risk factors of non-curative resection of early gastric cancer, were analyzed retrospectively.@*RESULTS@#23.4% (96/411) of the 411 cases were adenoma/low-grade dysplasia and 76.6% (315/411) were early gastric cancer. The latter included 28.0% (115/411) non-invasive carcinoma/high-grade dysplasia and 48.7% (200/411) invasive carcinoma. The concordance rate of pathological diagnosis between endoscopic forceps biopsies and ESD specimens was 66.0% (264/400), correlating with pathological diagnosis and lesion location (P < 0.01). The rate of upgraded diagnosis and downgraded diagnosis after ESD was 29.8% (119/400) and 4.2% (17/400), respectively. Among the 315 cases of early gastric cancer, there were 277 cases (87.9%) of differentiated type and 38 cases (12.1%) of undifferentiated type. In the study, 262 cases (83.2%) met with absolute indication, while 53 cases (16.8%) met relative indication. En bloc and curative resection rates were 98.1% and 82.9%, respectively. Risk factors for non-curative resection included a long diameter >20 mm (OR=3.631, 95%CI: 1.170-11.270, P=0.026), tumor infiltration into submucosa (OR=69.761, 95%CI: 21.033-231.376, P < 0.001)and undifferentiated tumor histology (OR=16.950, 95%CI: 4.585-62.664, P < 0.001).@*CONCLUSION@#Several subjective and objective factors, such as the limitations of biopsy samples, the characteristics and distribution of the lesions, different pathological understanding, and the endoscopic sampling and observation, can lead to the differences between the preoperative and postoperative pathological diagnosis of ESD. In particular, the pathological upgrade of postoperative diagnosis was more significant and should receive more attention by endoscopists and pathologists. The curative resection rate of early gastric cancer in ESD was high. Non-curative resection was related to the long diameter, the depth of tumor invasion and histological classification. ESD can also be performed in undifferentiated early gastric cancer if meeting the indication criteria. The comprehensive and standardized pathological analysis of ESD specimens is clinically important to evaluate the curative effect of ESD operation and patient outcomes.

Establishment and efficacy evaluation of deep learning model for cardiac conduction system / 中国法医学杂志

Objective To investigate the recognition efficiency of AI model based on deep learning for cardiac conduction system(CCS).Methods HE staining sections of cardiac muscle and CCS of 17 cases of non-sudden death were selected,and the gold standard was unanimous recognition by 2 forensic pathologists with more than 20 years of CCS diagnosis experience.Inception V3 algorithm was used to establish AI model and complete CCS identification training and testing.Confusion matrix,accuracy,precision,recall,F1 score,ROC curve and AUC value were used to evaluate the effectiveness of AI model,and accuracy,sensitivity and specificity were used to evaluate the efficiency of manual independent and AI-assisted manual recognition for CCS.Results The accuracy of AI model was 87.3%,the precision was 91.9%,the recall was 81.9%,the F1 score was 86.6%,and the AUC value was 95.3%.The accuracy of AI model was higher than that of senior forensic pathologists.There was no statistical significance in the accuracy of AI-assisted senior forensic pathologists in identifying CCS compared with manual independent detection(P>0.05),while the accuracy of AI-assisted intermediate and junior forensic pathologists in identifying CCS was increased by 8%and 14.33%,respectively,with statistical significance(P<0.05).The accuracy rate of AI-assisted junior forensic pathologists to identify CCS was higher than that of intermediate forensic pathologists in self-diagnosis.Conclusion The AI model could be used for the automatic recognition of CCS,and could improve the diagnostic efficiency of CCS and narrow the gap between the forensic pathologists with low experience and that with high experience.

Knowledge map of artificial intelligence applied in forensic medicine / 中国法医学杂志

Objective To conduct a comprehensive visual analysis of the application of Artificial Intelligence(AI)in forensic medicine using bibliometric tools so as to create knowledge maps of cooperation network,research hotspots,important findings,and potential future trends in this field.Methods The Web of Science(WoSCC)was utilized as the primary data source,search formula incorporating AI and forensic medicine as core subject words was constructed,resulting in a dataset comprising 2 287 literature records.Vosviewer,Citespace,and Bibliometrix were employed for analyzing various aspects such as cooperation network,keyword co-occurrence networks,clustering dynamics,clusters,centrality degree and thematic strategic coordinate charts.These analyses facilitated the creation of corresponding visual maps.Results The collaboration among authors still requires further strengthening;however significant groups have emerged among institutions and countries.Research hotspots and important findings predominantly revolve around algorithmic applications.Furthermore,"identification"related research appears to become a prominent future research trend.Conclusion By employing bibliometric analysis techniques on the application of artificial intelligence in forensic medicine domain,this study successfully elucidats cooperation networks,research hotspots,important findings,future research directions,and provides objective support through empirical evidence for related studies.

Effect of penehyclidine hydrochloride on respiratory mechanics, arterial blood gas, and inflammatory factors in patients undergoing one-lung ventilation during thoracoscopic lobectomy / 中国基层医药

Objective:To investigate the effect of penehyclidine hydrochloride on respiratory mechanics, arterial blood gas, and inflammatory factors in patients undergoing one-lung ventilation during thoracoscopic lobectomy.Methods:A total of 100 patients who underwent thoracoscopic lobectomy with one-lung ventilation at Jinhua Central Hospital from January to November 2022 were included in this randomized controlled study. They were divided into groups A and B ( n = 50 per group) using a random digital number table. Patients in group A received an intravenous infusion of 0.02 mg/kg of pentylenethyclidine hydrochloride 30 minutes before surgery, while patients in group B received an equal amount of 0.9% sodium chloride injection 30 minutes before surgery. Clinical indicators, respiratory mechanical indicators (peak airway pressure, lung compliance), arterial blood gas analysis indicators (blood oxygen saturation, arterial pressure of oxygen, oxygenation index), inflammatory factor levels (interleukin-6, interleukin-8, tumor necrosis factor level-α), and pulmonary complications were compared between the two groups. Results:There were no significant differences in mechanical ventilation time or total infusion volume between the two groups (both P > 0.05). At the end of surgery (T1) and 1 day after surgery (T2), peak airway pressure in group A was (17.43 ± 2.69) cm H 2O and (16.81 ± 2.28) cm H 2O (1 cm H 2O = 0.098 kPa), respectively, which were significantly lower than (19.23 ± 3.40) cm H 2O and (18.29 ± 2.06) cm H 2O in group B, respectively ( t = 2.94, 3.41, P = 0.002, < 0.001). At T1 and T2, lung compliance in group A was (34.67 ± 2.93) cm H 2O and (36.26 ± 3.11) cm H 2O, respectively, which were significantly higher than (32.23 ± 2.85) cm H 2O and (33.84 ± 2.87) cm H 2O in group B, respectively ( t = 4.22, 4.04, P = 0.000, < 0.001). At T1 and T2, blood oxygen saturation, arterial partial pressure of oxygen, and oxygenation index in group A were significantly higher than those in group B ( t = 8.12, 3.07, 10.47, 3.16, 3.81, 4.15, all P < 0.05). At T1 and T2, interleukin-6, interleukin-8, and tumor necrosis factor-α levels in group A were significantly lower than those in group B ( t = 11.67, 13.55, 9.60, 15.71, 6.13, 11.50, all P < 0.001). The incidence of complications in group A was 4% (2/50), which was significantly lower than 16% (8/50) in group B ( χ2 = 4.00, P < 0.05). Conclusion:Penehyclidine hydrochloride has a good effect on respiratory mechanics, arterial blood gas, and inflammatory factors in patients undergoing thoracoscopic lobectomy with one-lung ventilation and thereby deserves clinical promotion.

Changes of thickness and area of ligamenta flavum after lateral lumbar interbody fusion / 中华骨科杂志

Objective:To investigate the changes of thickness and area of the ligamentum flavum after lateral lumbar interbody fusion (LLIF) for lumbar degenerative diseases.Methods:From 2019 to 2021, a total of 54 patients with lumbar degenerative diseases who underwent LLIF combined with percutaneous pedicle screw internal fixation were retrospectively analyzed. There were 9 males and 45 females, aged 59.46±6.91 years (range, 45-76 years), followed up for 14.69±6.87 months (range, 12-33 months). The disc height (DH), midsagittal canal diameter (CD), dural sac axial cross-sectional area (DCSA), ligamentum flavum area (LFA) and ligamentum flavum thickness (LFT) before and after surgery and at the last follow-up were evaluated and compared. Pearson correlation analysis was used to assess the relationship between the amount of change in the DCSA and LFA in the immediate postoperative period and at the last follow-up, as well as the correlation between the two and the amount of change in the DH. The data of patients at the last follow-up of 12 months after operation were extracted. Pearson correlation was used to evaluate the changes in DCSA and LFA at the last follow-up and the visual analogue scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI) at 1 year after surgery.Results:All patients were followed up for 14.69±6.87 months (range, 12-33 months). The differences in DH ( F=354.93, P<0.001), sagittal CD ( F=44.78, P<0.001) and DCSA ( F=130.97, P<0.001) before, immediately after surgery and at the last follow-up were statistically significant. The DH, sagittal CD, and DCSA immediate after surgery and last follow-up were higher than those before surgery ( P<0.05). The differences in LFA ( F=51.59, P<0.001) and bilateral LFT ( F=53.49, P<0.001; F=50.53, P<0.001) before and after surgery and at the last follow-up were statistically significant, and both LFA and bilateral LFT at immediate after surgery and last follow-up were smaller than those before surgery ( P<0.05). Pearson correlation analysis showed that the change of DH immediately after surgery was moderately correlated with the change of DCSA ( r=0.57, P<0.001), and was strongly correlated with the change of LFA ( r=0.65, P<0.001). The change of DH at the last follow-up was moderately correlated with the change of DCSA ( r=0.43, P<0.001), and was weakly correlated with the change of LFA ( r=0.25, P=0.042). The differences in VAS-leg ( F=199.51, P<0.001), VAS-low back ( F=233.90, P<0.001), and ODI ( F=199.17, P<0.001) were statistically significant in patients before operation, 3 months after operation and 12 months after operation. There was no correlation between the changes of DCSA and LFA at the last follow-up and the changes of VAS and ODI at 1 year after operation ( P>0.05). Conclusion:LFA and LFT decrease and DCSA increase in patients with lumbar degenerative diseases after LLIF. LFA and LFT gradually decrease with time, and VAS and ODI are significantly improved compared with those before surgery. The DH loss caused by a certain degree of cage subsidence after surgery does not affect the clinical efficacy. There is no correlation between the improvement of DCSA and LFA and the improvement of clinical symptoms.

2023 China Guidelines for Lipid Management / 老年心脏病学杂志（英文版）

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among urban and rural residents in China, and elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for ASCVD. Considering the increasing burden of ASCVD, lipid management is of the utmost importance. In recent years, research on blood lipids has made breakthroughs around the world, hence a revision of China guidelines for lipid management is imperative, especially since the target lipid levels in the general population vary in respect to the risk of ASCVD. The level of LDL-C, which can be regarded as appropriate in a population without frisk factors, can be considered abnormal in people at high risk of developing ASCVD. As a result, the "Guidelines for the prevention and treatment of dyslipidemia" were adapted into the "China Guidelines for Lipid Management" (henceforth referred to as the new guidelines) by an Experts' committee after careful deliberation. The new guidelines still recommend LDL-C as the primary target for lipid control, with CVD risk stratification to determine its target value. These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle, be used as an initial line of treatment, followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, as necessary. The new guidelines provide guidance for lipid management across various age groups, from children to the elderly. The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.

A comparative study of detection methods for assessing superior and inferior vestibular nerve damages in patients with vestibular neuritis / 临床耳鼻咽喉头颈外科杂志

Objective:This study aims to compare the examination results of the vestibular evoked myogenic potential（VEMP） and video head impulse testing（vHIT） in patients with vestibular neuritis（VN）, thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients, and their feasibility. Methods:A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited. They were respectively tested for ocular VEMP（oVEMP）, cervical VEMP（cVEMP） and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%（24/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%（26/26）. Examination results of cVEMP showed that 36%（9/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%（10/25）, and 60%（15/25） patients had normal waveforms of both ears. Examination results of vHIT showed that 100%（25/25） patients had semicircular canal gain decline of one side, 92%（23/25） had anterior Semicircular canal decline of one side, and 36%（9/25） had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%（15/25） VN patients had superior vestibular nerve damage, and 40%（10/25） had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%（16/25） VN patients had superior vestibular nerve damage, and 36%（9/25） had both superior and inferior vestibular nerve damages. There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHIT（χ²=0.085, P>0.05）. The matching ratio of VEMP and vHIT results was 80%（20/25）, and the non-matching ratio was 20%（5/25）. Conclusion:Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage. If their results are not consistent, it is recommended not to identify the scope of the vestibular nerve damage.

Study on clinical characteristics and surgical methods of bucket-handle meniscal tears / 中国修复重建外科杂志

OBJECTIVE@#To summarize the clinical features, surgical methods, and prognosis of bucket-handle meniscal tears (BHMTs), and provide guidance for clinical treatment.@*METHODS@#The clinical data of 91 BHMTs patients (91 knees), who met the selection criteria and were admitted between January 2015 and January 2021, was retrospectively analyzed. There were 68 males and 23 females. Age ranged from 16 to 58 years with an average of 34.4 years. The injury was caused by sports in 68 cases, traffic accident in 15 cases, and falls or sprains in 8 cases. There were 49 cases of left knee injury and 42 cases of right knee injury. The time from the onset of symptoms to the admission ranged from 1 day to 13 months (median, 18 days), including >1 month in 35 cases and ≤1 month in 56 cases. Medial BHMTs occurred in 52 cases and lateral BHMTs in 39 cases. There were 36 cases with ACL rupture and 12 cases with discoid meniscus. The knee extension was limited more than 10° in 55 cases. According to the condition of meniscus injury, the meniscus suture with Inside-out combined with All-inside techniques (54 cases) or meniscoplasty (37 cases) under arthroscopy were selected. ACL reconstruction was performed in all patients with ACL rupture with autogenous hamstring tendon. Postoperative complications were observed. International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were used to evaluate knee function, and clinical failure was recorded.@*RESULTS@#Two patients developed intermuscular venous thrombosis, which improved after oral anticoagulant therapy. No vascular injury, postoperative infection, joint stiffness, or other complications occurred in all patients. All patients were followed up 24-95 months, with a median of 64 months. A total of 12 cases (13.19%) failed the operation and were re-operated or given oral anti-inflammatory analgesics and rehabilitation therapy. At last follow-up, IKDC score and Lysholm score of 91 patients significantly increased when compared with those before operation ( P<0.05), while Tegner score significantly decreased ( P<0.05). The above indexes of patients treated with meniscus suture and meniscoplasty were also significantly different from those before operation ( P<0.05).@*CONCLUSION@#BHMTs occurs mostly in young men and is one of the important reasons for the limitation of knee extension after trauma. Arthroscopic meniscus suture and meniscoplasty can obtain good effectiveness according to individual conditions of patients. But the latter can better preserve the shape and function of meniscus, and theoretically can obtain better long-term outcomes, which needs to be confirmed by further research with larger sample size.

Relationship between blood transfusion factors and early postoperative outcomes in patients undergoing orthotopic liver transplantation / 中华麻醉学杂志

Objective:To evaluate the relationship between blood transfusion factors (massive transfusion, transfusion of stored red blood cells and anhepatic transfusion) and early postoperative outcomes in the patients undergoing orthotopic liver transplantation.Methods:Patients with end-stage liver disease who underwent orthotopic liver transplantation and intraoperative blood transfusion from January 2021 to March 2022 in our hospital were retrospectively selected, and their clinical data were collected. The patients were divided into massive transfusion group (M group, total red blood cell transfusion ≥10 U) and non-massive transfusion group (NM group) according to the amount of intraoperative blood transfused. The patients were divided into fresh blood group (NS group) and stored blood group (S group, red blood cell storage time > 2 weeks) according to the storage time of red blood cells transfused. The patients were divided into transfusion in anhepatic stage group (group T) and nontransfusion in anhepatic stage group (group NT) according to whether blood was transfused in the anhepatic stage. Multivariate logistic regression, generalized linear model and generalized linear mixed model were used to analyze the relationship between blood transfusion factors and primary outcome measures (postoperative pulmonary complications, circulation overload, acute kidney injury, abdominal infection, thrombosis) and between blood transfusion factors and secondary outcome measures (duration of ICU stay, postoperative hospitalization, postoperative temperature ≥38.5 ℃ at any time point after surgery, postoperative liver and kidney function index, coagulation function index, platelet count and preoperative difference).Results:One hundred and six patients were enrolled in this study. The results of multivariate logistic regression analysis: Massive blood transfusion and infusion of stored blood were risk factors for postoperative pulmonary complications, massive blood transfusion was a risk factor for abdominal infection, Child-Turcotte-Pugh score for liver function and time of anhepatic phase were risk factors for postoperative acute kidney injury, Child-Turcotte-Pugh score was a risk factor for circulatory overload, and age and massive blood transfusion were risk factors for thrombosis ( P<0.05). The results of generalized linear model analysis: Intraoperative stored blood transfusion and blood transfusion during the anhepatic phase were risk factors for prolonged duration of ICU stay, massive blood transfusion, intraoperative stored blood transfusion and blood transfusion during the anhepatic phase were risk factors for prolonged hospitalization ( P<0.05), and there was no correlation between massive blood transfusion, intraoperative stored blood transfusion and blood transfusion during the anhepatic phase and temperature ≥38.5 ℃ at any time point after surgery ( P>0.05). The results of generalized linear mixed model analysis: There was statistically significant difference in the difference between preoperative and postoperative liver and kidney function indexes, coagulation function indexes and platelet counts in the patients with or without massive transfusion, stored blood transfusion or blood transfusion during the anhepatic phase ( P<0.05). Conclusions:Massive blood transfusion and infusion of stored blood are the main risk factors for early adverse outcomes after orthotopic liver transplantation in the patients.

Metabolic Disease Management Guideline for National Metabolic Management Center(2nd edition) / 中华内分泌代谢杂志

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Anzhen hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19 / 中华胸心血管外科杂志

The end of the COVID-19 infection peak in 2022 prompts a backlog of cardiovascular surgical patients to gradually return to the hospital, resulting in a surge in cardiovascular surgeries. However, against the backdrop of the COVID-19 pandemic, the clinical practice of cardiovascular surgery faces many problems. Therefore, organized by Beijing Anzhen Hospital, experts in cardiovascular surgery and related fields have formulated hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19. This article summarizes the clinical decision-making of patients requiring cardiovascular surgery after COVID-19 infection, and advises on the corresponding recommendations according to the existing evidence-based medical evidence as well as the actual clinical practice experience of relevant experts. The main content of the article includes special requirements for cardiovascular surgical treatment indications in patients with COVID-19 infection, selection of surgical timing, special requirements of preoperative, intraoperative and postoperative management, etc., which aims to provide COVID-19-infected patients with guidance on rational decision-making when receiving cardiovascular surgery.

Research Progress of Metabolomics Techniques Combined with Machine Learning Algorithm in Wound Age Estimation / 法医学杂志

Wound age estimation is the core content in the practice of forensic medicine. Accurate estimation of wound age is a scientific question that needs to be urgently solved by forensic scientists at home and abroad. Metabolomics techniques can effectively detect endogenous metabolites produced by internal or external stimulating factors and describe the dynamic changes of metabolites in vivo. It has the advantages of strong operability, high detection efficiency and accurate quantitative results. Machine learning algorithm has special advantages in processing high-dimensional data sets, which can effectively mine biological information and truly reflect the physiological, disease or injury state of the body. It is a new technical means for efficiently processing high-throughput big data. This paper reviews the status and advantages of metabolomic techniques combined with machine learning algorithm in the research of wound age estimation, and provides new ideas for this research.

The long-term durability of valved homograft conduit in right ventricular outflow tract reconstruction after Ross surgery and non-Ross surgery / 中国胸心血管外科临床杂志

@#Objective    To compare the long-term durability of valved homograft conduit (VHC) in patients with Ross and non-Ross right ventricular outflow tract (RVOT) reconstruction. Methods    Patients who underwent RVOT reconstruction using VHC in Fuwai Hospital from January 2008 to October 2020 were retrospectively included. Patients who received Ross RVOT reconstruction were allocated to a Ross group and patients who received non-Ross RVOT reconstruction were allocated to a non-Ross group. The survival and reintervention-free rates of the two groups were evaluated with the Kaplan-Meier survival curve and log-rank test. The propensity score matching analysis was performed on the patients who completed ultrasound follow-up in the two groups, and the VHC dysfunction-free rate was compared between the two groups. Results    A total of 243 patients were enrolled, including 142 males and 101 females, with a median age of 6 years (4 months to 56 years). There were 77 patients in the ROSS group and 166 patients (168 operations) in the non-ROSS group. The cardiopulmonary bypass time in the Ross group was shorter than that in the non-Ross group (175.4±45.6 min vs. 200.1±83.5 min, P=0.003). Five patients in the non-Ross group died early after the operation. The follow-up was available in 231 patients (93.1%), with the average follow-up time of 61.7±44.4 months. During the follow-up, 5 patients in the non-Ross group died. The 12-year survival rate was 100.0% in the Ross group and 93.2% in the non-Ross group (log-rank, P=0.026). In addition, 1 patient in the Ross group and 7 patients in the non-Ross group received VHC reintervention. There was no significant difference in the reintervention-free rate between the two groups (log-rank, P=0.096). Among the 73 patients in the Ross group and 147 patients in non-Ross group who were followed up by ultrasound after discharge, 45 patients (20.5%) developed VHC dysfunction. Before matching, the long-term durability of VHC in the Ross group was better than that in non-Ross group (10-year VHC dysfunction-free rate: 66.6% vs. 37.1%, log-rank, P=0.025). After the propensity score matching, 64 patients included in each group, and there was no statistical difference in the long-term durability of VHC between the two groups (10-year VHC dysfunction-free rate: 76.3% vs. 43.0%, log-rank, P=0.065). In the subgroup analysis, the 10-year VHC dysfunction-free rate in the Ross group was higher than that in the non-Ross group (71.0% vs. 20.0%, log-rank, P=0.032) among patients aged<6 years at surgery. However, there was no significant difference in the 10-year VHC dysfunction-free rate between the two groups (53.7% vs. 56.7%, log-rank, P=0.218) among patients aged ≥6 years at surgery. Conclusion    After the propensity score matching analysis, the long-term durability of VHC has no significant difference between the Ross group and non-Ross group. The long-term durability of VHC after Ross surgery is superior to that of non-Ross surgery in patients aged<6 years at surgery.