What triggers phenological events in plants under seasonal environments? A study with phylogenetically related plant species in sympatry / O que desencadeia eventos fenológicos em plantas em ambientes sazonais? Um estudo com espécies de plantas filogeneticamente relacionadas e em simpatria

In this study, we evaluated variation in vegetative and reproductive phenological events of four phylogenetically related plant species subjected to a seasonal environment. To this aim, we sampled 15 individuals of each plant species every fortnight for one year, between January and December of 2017. To assess when a given phenophase occurred more intensely in the population, the Fournier intensity index was used and the synchrony of individuals of the sample in a given phenological event was estimated using the activity index. The Rayleigh (Z) test was used to determine whether the phenological events have seasonal distribution. The relationship of abiotic factors (photoperiod, precipitation, relative humidity and temperature) with the intensity of phenophases was evaluated for each plant species using generalized linear models (GLMs). The phenophases of all plants showed a seasonal distribution pattern, as well as variation in synchrony of phenophases and specific sets of abiotic factors significantly influenced their phenophases. New leaves, for example, were produced throughout the seasons, with intense leaf fall in the dry season. Flowering periods, on the other hand, did not overlap. Indeed, species exhibited sequential flowering and asynchronous flowering among individuals. Our results suggest that the phenological patterns of four sympatric plant species are directly linked to climatic variables, but different abiotic factors affected different phenophases.

Neste estudo, avaliamos a variação nos eventos fenológicos vegetativos e reprodutivos de quatro espécies de plantas filogeneticamente relacionadas submetidas a um ambiente sazonal. Para isso, amostramos 15 indivíduos de cada espécie quinzenalmente, pelo período de um ano, entre janeiro e dezembro de 2017. Para avaliar quando uma determinada fenofase ocorreu de modo mais intenso na população foi utilizado o índice de intensidade de Fournier e a sincronia dos indivíduos da amostra em determinado evento fenológico foi estimada utilizando-se o índice de atividade. O teste de Rayleigh (Z) foi usado para determinar se os eventos fenológicos têm distribuição sazonal. A relação dos fatores abióticos (fotoperíodo, precipitação, temperatura e umidade relativa) com a intensidade das fenofases foi avaliada para cada espécie de planta usando modelos lineares generalizados (GLMs). As fenofases de todas as plantas apresentaram um padrão de distribuição sazonal, bem como variação na sincronia das fenofases e conjuntos específicos de fatores abióticos influenciaram significativamente suas fenofases. Folhas novas, por exemplo, foram produzidas ao longo das estações, com intensa queda de folhas na estação seca. Os períodos de floração, por outro lado, não se sobrepuseram. De fato, as espécies exibiram floração sequencial e floração assíncrona entre os indivíduos. Nossos resultados sugerem que os padrões fenológicos das quatro espécies de plantas simpátricas estão diretamente ligados às variáveis climáticas, mas diferentes fatores abióticos afetaram diferentes fenofases.

Analysis on Components Absorbed into Blood and Cerebrospinal Fluid of Schisandrae Chinensis Fructus Based on Sequential Metabolism / 中国实验方剂学杂志

ObjectiveTo identify the prototypical components and metabolites absorbed into blood and cerebrospinal fluid of Schisandrae Chinensis Fructus（SCF） based on sequential metabolism combined with liquid chromatography-mass spectrometry. MethodBlood and cerebrospinal fluid samples of integrated metabolism， intestinal metabolism and hepatic metabolism were collected from male SD rats after gavage and in situ intestinal perfusion administration， and ultra-performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry（UPLC Q-Exactive Orbitrap MS） was used to analyze and compare the differences in the spectra of SCF extract， blank plasma， administered plasma， blank cerebrospinal fluid and administered cerebrospinal fluid with ACQUITY UPLC BEH Shield RP18 column（2.1 mm×100 mm， 1.7 µm）， the mobile phase was acetonitrile（A）-0.1% formic acid aqueous solution（B） for gradient elution（0-7 min， 95%B； 7-12 min， 95%-35%B； 12-17 min， 35%-15%B； 17-20 min， 15%-12%B； 20-22 min， 12%-5%B； 22-23 min， 5%B； 23-25 min， 5%-95%B； 25-28 min， 95%B）. And heated electrospray ionization（HESI） was used with positive and negative ion modes， the scanning range was m/z 100-1 500. The prototypical constituents and their metabolites absorbed into blood and cerebrospinal fluid of SCF were identified according to the retention time， characteristic fragments， molecular formulae and the information of reference substances. ResultA total of 42 chemical components were identified in the extract of SCF， including lignans， flavonoids， amino acids， tannins， and others， of which lignans were the main ones. A total of 27 prototypical components and 14 metabolites were identified in plasma samples from different sites. A total of 15 prototypical components and 9 metabolites were identified in cerebrospinal fluid. The main metabolic reactions involved in the formation of metabolites were mainly demethylation， methylation， demethoxylation and hydroxylation. ConclusionThrough the systematic identification of the prototypical components and metabolites of SCF in rats， it provides data support for further better exploring the material basis of SCF in the treatment of central nervous system diseases.

Staging Sequential Treatment of Ischemic Stroke Based on Syndrome Differentiation of Deficiency and Excess in Eight Principles / 中国实验方剂学杂志

The core of diagnosing and treating diseases in traditional Chinese medicine lies in syndrome differentiation. The eight principles of syndrome differentiation serve as guidance for syndrome differentiation. As one of the eight principles of syndrome differentiation， the differentiation of deficiency and excess is the basic and critical method. Ischemic stroke is currently the leading cause harming the health of Chinese residents. Although the hypotheses about the cause of ischemic stroke have evolved from external wind to the later internal wind and to the modern theory of toxin damaging the brain collaterals， they all believe that this disease is rooted in internal deficiency and external excess. According to available studies， although stroke is characterized by complex pathogenesis and rapid progression of syndromes， the key cause evolution has a regularity， that is， from excess to deficiency. This article analyzes the historical evolution of the etiology， pathogenesis， and syndrome differentiation schemes of stroke. There are diverse schemes for the syndrome differentiation of stroke， which make it difficult to choose in clinical practice. In view of this problem， this paper puts forward a new approach of staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess according to the evolution law of the key cause of stroke. Furthermore， we conducted a randomized controlled study on 100 patients with ischemic stroke to evaluate this new approach. The results showed that the staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess demonstrated definite clinical efficacy. In addition， this article reviews the previous research results of our team and the research achievements of other teams to preliminarily explore the relationship between stroke syndromes and biomarkers， aiming to provide an objective basis for unveiling the pathogenesis of stroke. In summary， according to the key cause evolution （from excess to deficiency）， the treatment of ischemic stroke by stages based on differentiation of deficiency and excess can facilitate the rapid intervention and improve the clinical efficacy on ischemic stroke.

Theta Oscillations Support Prefrontal-hippocampal Interactions in Sequential Working Memory / 神经科学通报·英文版

The prefrontal cortex and hippocampus may support sequential working memory beyond episodic memory and spatial navigation. This stereoelectroencephalography (SEEG) study investigated how the dorsolateral prefrontal cortex (DLPFC) interacts with the hippocampus in the online processing of sequential information. Twenty patients with epilepsy (eight women, age 27.6 ± 8.2 years) completed a line ordering task with SEEG recordings over the DLPFC and the hippocampus. Participants showed longer thinking times and more recall errors when asked to arrange random lines clockwise (random trials) than to maintain ordered lines (ordered trials) before recalling the orientation of a particular line. First, the ordering-related increase in thinking time and recall error was associated with a transient theta power increase in the hippocampus and a sustained theta power increase in the DLPFC (3-10 Hz). In particular, the hippocampal theta power increase correlated with the memory precision of line orientation. Second, theta phase coherences between the DLPFC and hippocampus were enhanced for ordering, especially for more precisely memorized lines. Third, the theta band DLPFC → hippocampus influence was selectively enhanced for ordering, especially for more precisely memorized lines. This study suggests that theta oscillations may support DLPFC-hippocampal interactions in the online processing of sequential information.

What triggers phenological events in plants under seasonal environments? A study with phylogenetically related plant species in sympatry

Abstract In this study, we evaluated variation in vegetative and reproductive phenological events of four phylogenetically related plant species subjected to a seasonal environment. To this aim, we sampled 15 individuals of each plant species every fortnight for one year, between January and December of 2017. To assess when a given phenophase occurred more intensely in the population, the Fournier intensity index was used and the synchrony of individuals of the sample in a given phenological event was estimated using the activity index. The Rayleigh (Z) test was used to determine whether the phenological events have seasonal distribution. The relationship of abiotic factors (photoperiod, precipitation, relative humidity and temperature) with the intensity of phenophases was evaluated for each plant species using generalized linear models (GLMs). The phenophases of all plants showed a seasonal distribution pattern, as well as variation in synchrony of phenophases and specific sets of abiotic factors significantly influenced their phenophases. New leaves, for example, were produced throughout the seasons, with intense leaf fall in the dry season. Flowering periods, on the other hand, did not overlap. Indeed, species exhibited sequential flowering and asynchronous flowering among individuals. Our results suggest that the phenological patterns of four sympatric plant species are directly linked to climatic variables, but different abiotic factors affected different phenophases.

Resumo Neste estudo, avaliamos a variação nos eventos fenológicos vegetativos e reprodutivos de quatro espécies de plantas filogeneticamente relacionadas submetidas a um ambiente sazonal. Para isso, amostramos 15 indivíduos de cada espécie quinzenalmente, pelo período de um ano, entre janeiro e dezembro de 2017. Para avaliar quando uma determinada fenofase ocorreu de modo mais intenso na população foi utilizado o índice de intensidade de Fournier e a sincronia dos indivíduos da amostra em determinado evento fenológico foi estimada utilizando-se o índice de atividade. O teste de Rayleigh (Z) foi usado para determinar se os eventos fenológicos têm distribuição sazonal. A relação dos fatores abióticos (fotoperíodo, precipitação, temperatura e umidade relativa) com a intensidade das fenofases foi avaliada para cada espécie de planta usando modelos lineares generalizados (GLMs). As fenofases de todas as plantas apresentaram um padrão de distribuição sazonal, bem como variação na sincronia das fenofases e conjuntos específicos de fatores abióticos influenciaram significativamente suas fenofases. Folhas novas, por exemplo, foram produzidas ao longo das estações, com intensa queda de folhas na estação seca. Os períodos de floração, por outro lado, não se sobrepuseram. De fato, as espécies exibiram floração sequencial e floração assíncrona entre os indivíduos. Nossos resultados sugerem que os padrões fenológicos das quatro espécies de plantas simpátricas estão diretamente ligados às variáveis climáticas, mas diferentes fatores abióticos afetaram diferentes fenofases.

A retrospective and comparative study between quick sequential organ failure assessment, CURB-65, and early warning scorings in COVID-19 patients to predict the disease severity and outcome

Background: Predicting the severity of COVID-19 infection in advance is the key to success of its treatment outcome. Various scoring systems are used to detect the severity of this disease but this study targets three simple scoring systems based on the vital parameters and basic routine laboratory tests. Aims and Objectives: The aim of the study was to assess the predictability of three scoring systems (Quick sequential organ failure assessment [q SOFA], CURB-65, and Early Warning scoring system) for disease severity at presentation in a rural-based tertiary care center. Materials and Methods: An observational, descriptive, retrospective, and cross-sectional study was conducted at Diamond Harbour Government Medical College Covid Hospital from January 2021 to January 2022 to assess the predictability of q SOFA, CURB-65, and Early Warning scoring system for disease severity at presentation. Results: The total number of participants was 561 among total admitted 1367 patients. A short descriptive analysis obtained from the variables to analyze the scorings howed among total sample collected, 57% were male and 43% were female. In this study, 87% of patients were survived and the rest 13% succumbed (death). There is no statistically significant difference in mortality between both genders. Age, pulse rate, and respiratory rate have a significant correlation with the outcome and altered sensorium is also highly associated with mortality. The accuracy was also found to be little higher for National Early Warning score (NEWS) score than CURB-65 scoring and q SOFA scoring (0.919, 0.914 and 0.907). Although all the scoring systems have high sensitivity (>90%) (CURB 65: Most sensitive [0.99]), the specificities of all three scoring systems are below 50%. Among these three-scoring systems, NEWS showed the highest specificity (0.492) than q SOFA (0.423) and CURB 65 (0.394). Conclusion: We suggest NEWS score and CURB-65 as a better predictor for in-hospital mortality in COVID-19 patients as it is significantly sensitive and reasonably specific. It can be recommended in less equipped hospitals where only basic laboratory facilities are available. qSOFA can be utilized where no laboratory facility is available like in safe home and isolation centers.

Study of total antioxidant capacity of red raspberry (Rubus idaeous L. ) shoots. / Estudio de la capacidad antioxidante total de brotes de frambuesa roja (Rubus idaeous L. ).

Background: Today, cardiovascular, oncological, and neurodegenerative diseases are the main causes of death in the world, according to official World Health Organization (WHO) statistics. Antioxidants are used to treat and prevent these diseases. In order to develop optimal technology for obtaining drugs based on plant extracts with antioxidant action, it is necessary to determine the total antioxidant capacity of raspberry shoots. Objectives: The study aimed to determine the total antioxidant capacity of red raspberry shoots, study the content of biologically active substances (BAS), and the antioxidant activity of red raspberry shoot extracts obtained during subsequent exhaustive extraction. Methods: The number of phenolic compounds, catechins, flavonoids, and hydroxycinnamic acids was determined by a spectrophotometric analysis method, whereas organic acids were determined by the alkalimetric method in red raspberry shoot extracts; the antioxidant activity of obtained extracts was evaluated by potentiometric method. Results: The total antioxidant capacity of red raspberry shoots was 164.12 mmol-equiv./m dry weight, the sum of the total content of phenolic compounds was 24.40 mg gallic acid (GA)/mL, catechins ­ 21.36 mg epigallocatechin-3-O-gallate (EGCG)/mL, flavonoids ­ 0.77 mg rutin (R)/mL, hydroxycinnamic acids derivatives ­ 2.56 mg chlorogenic acid (ChA)/mL and organic acids ­ 1.88 mg citric acid (CA)/mL in red raspberry shoot extracts obtained during subsequent exhaustive extraction. The analysis showed that there is a very high positive correlation between antioxidant activity and total phenolic compounds, catechin, flavonoid, hydroxycinnamic acids derivatives, and organic acids content in red raspberry shoot extracts. Conclusions: Total red raspberry shoots' antioxidant capacity has been determined. The study results can be used to develop optimal technology for obtaining drugs based on the extract of red raspberry shoots, which has an antioxidant effect

Contexto: Hoy en día, las enfermedades cardiovasculares, oncológicas y neurodegenerativas son las principales causas de muerte en el mundo según estadísticas oficiales de la Organización Mundial de la Salud OMS. Los antioxidantes se utilizan para tratar y prevenir estas enfermedades. Para desarrollar una tecnología óptima para la obtención de fármacos a base de extractos de plantas con acción antioxidante, es necesario determinar la capacidad antioxidante total de los brotes de frambuesa.Objetivos: El estudio tuvo como objetivo determinar la capacidad antioxidante total de los brotes de frambuesa roja, estudiar el contenido de sustancias biológicamente activas (SBA) y la actividad antioxidante de los extractos de brotes de frambuesa roja obtenidos mediante extracción exhaustiva. Métodos: La cantidad de compuestos fenólicos, catequinas, flavonoides y ácidos hidroxicinámicos se determinó por método de análisis espectrofotométrico, mientras que los ácidos orgánicos por método alcalimétrico en extractos de brotes de frambuesa roja; La actividad antioxidante de los extractos obtenidos se evaluó por método potenciométrico. Resultados: La capacidad antioxidante total de los brotes de frambuesa roja fue de 164.12 mmol-equiv./m de peso seco, la suma del contenido total de compuestos fenólicos fue de 24.40 mg gálico ácido (GA)/mL, catequinas ­ 21.36 mg epigalocatequina-3-O-galato (EGCG)/mL, flavonoides ­ 0.77 mg rutina (R)/mL, derivados de ácidos hidroxicinámicos ­ 2.56 mg clorogénico ácido (ChA)/mL y ácidos orgánicos ­ 1.88 mg cítrico ácido (CA)/mL en extractos de brotes de frambuesa roja obtenidos durante extracción exhaustiva. La correlación analizada mostró que existe una correlación positiva entre la actividad antioxidante y el contenido de compuestos fenólicos totales, catequinas, flavonoides, derivados de ácidos hidroxicinámicos y ácidos orgánicos en extractos de brotes de frambuesa roja. Conclusiones: Gracias a nuestros resultados se ha determinado la capacidad antioxidante total de los brotes de frambuesa roja. Los resultados del estudio se pueden utilizar para desarrollar una tecnología óptima para la obtención de fármacos basados en el extracto de brotes de frambuesa roja, que tiene un efecto antioxidante

Analysis on Components Absorbed into Blood of Citri Reticulatae Pericarpium in Rats Based on Sequential Metabolism and UPLC-HRMS / 中国实验方剂学杂志

ObjectiveTo study the metabolism of chemical components from Citri Reticulatae Pericarpium（CRP）in different parts of rats by sequential metabolism and ultra performance liquid chromatography-high resolution mass spectrometry（UPLC-HRMS）. MethodSD male rats were employed as experimental subjects， and blood samples of intestinal metabolism and hepatic metabolism were prepared after administration of CRP ethanol extract by in situ intestinal perfusion， and comprehensive metabolic samples were collected after intragastric administration. UPLC-HRMS was used to analyze the samples with acetonitrile（A）-0.1% formic acid aqueous solution（B）as the mobile phase for gradient elution（0-10 min， 10%-30%A； 10-30 min， 30%-95%A； 30-31 min， 95%-10%A； 31-35 min， 10%A）at a flow rate of 0.35 mL·min-1， using a heated electrospray ionization with positive and negative ion mode scanning in the range of m/z 100-1 500. Under these conditions， the differences in the profiles of CRP ethanol extract， blank plasma and drug-containing plasma under different treatment groups were compared， and the chemical components of each sample were analyzed and identified based on the retention time， accurate relative molecular mass， primary and secondary ion fragments， and the information of reference substances. ResultA total of 44 chemical components were identified in the CRP ethanol extract， including flavone-O-glycosides， flavone-C-glycosides and polymethoxyflavonoids， etc. The results of sequential metabolism showed that 22 chemical components in CRP were detected in the intestinal metabolic sample， 18 chemical components were detected in the hepatic metabolic sample， and 9 identical chemical components（narirutin， hesperidin， meranzin， 5，7，8，3ʹ，4ʹ，5ʹ-hexamethoxy-flavone， isosinensetin， sinensetin， 3，5，6，7，8，3ʹ，4ʹ-heptamethoxyflavone， nobiletin and tangeretin）could be detected in all three metabolic samples， with a total of 22 compounds entering the blood in prototype form. ConclusionThe identified 21 components with well-defined structures entering the blood as prototypes may be potential active components of CRP， and differences in the components at different metabolic parts can provide an experimental basis for elucidating the in vivo biotransformation process of the metabolic components of CRP.

Death-Related Factors in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Treated by Sequential Mechanical Ventilation / 中国医学科学院学报

Objective To analyze the death-related factors of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated by sequential mechanical ventilation,so as to provide evidence for clinical practice. Methods The clinical data of 1204 elderly patients (≥60 years old) with AECOPD treated by sequential mechanical ventilation from June 2015 to June 2021 were retrospectively analyzed.The probability and influencing factors of death were analyzed. Results Among the 1204 elderly patients with AECOPD treated by sequential mechanical ventilation,167 (13.87%) died.Multivariate analysis showed that plasma procalcitonin ≥0.5 μg/L (OR=2.762, 95%CI=1.920-3.972, P<0.001),daily invasive ventilation time ≥12 h (OR=2.202, 95%CI=1.487-3.262,P<0.001),multi-drug resistant bacterial infection (OR=1.790,95%CI=1.237-2.591,P=0.002),oxygenation index<39.90 kPa (OR=2.447,95%CI=1.625-3.685,P<0.001),glycosylated hemoglobin >6% (OR=2.288,95%CI=1.509-3.470,P<0.001),and acute physiology and chronic health evaluation Ⅱ score ≥25 points (OR=2.126,95%CI=1.432-3.156,P<0.001) were independent risk factors for death in patients with AECOPD treated by sequential mechanical ventilation.Oral care>twice/d (OR=0.676,95%CI=0.457-1.000,P=0.048) and sputum excretion>twice/d (OR=0.492, 95%CI=0.311-0.776, P=0.002) were independent protective factors for death in elderly patients with AECOPD treated by sequential mechanical ventilation. Conclusions The outcomes of sequential mechanical ventilation in the treatment of elderly patients with AECOPD are affected by a variety of factors.To reduce the mortality,we put forward the following measures:attaching great importance to severe patients,restoring oxygenation function,shortening unnecessary invasive ventilation time,controlling blood glucose,preventing multidrug resistant bacterial infection,oral care twice a day,and sputum excretion twice a day.

Efficacy of Chinese medicine Kuntai capsule combined with sequential estrogen progesterone therapy in treatment of early-onset ovarian dysfunction / 中华全科医师杂志

Clinical data of 102 patients with premature ovarian failure admitted to Zhang Zhongjing Hospital from December 2018 to December 2021 were retrospectively analyzed. Fifty-one patients received (control group), and another 51 patients received Chinse medicine Kuntai capsule in addition to sequential estrogen progesterone therapy(study group); both groups were treated for 3 menstrual cycles. After treatment, the total effective rate of the study group was higher than that of the control group (94.1% (48/51) vs. 72.6% (37/51), χ2=4.07, P=0.044). After treatment, the proportion of patients with mild Kupperman score and serum estradiol level in both groups were increased, and the proportion in study group was higher than that in the control group. The proportion of patients with moderate and severe Kupperman score and the total score decreased after treatment in both groups, and the proportion of patients with moderate Kupperman score in the study group was lower than that in the control group. Serum luteinizing hormone and folliclestimulating hormone levels were significantly decreased, and the levels in study group were lower than those in the control group. The levels of resistance index and PI were significantly decreased after treatment in both group and the study group decrease more markedly (all P<0.05). The peak systolic flow velocity level was increased after treatment in both groups and the study group increased more markedly (all P<0.05). It is suggested that the application of Chinese medicine Kuntai capsule combined with sequential estrogen progesterone therapy can effectively improve the clinical therapeutic effect, stabilize sex hormones, uterine microcirculation and effectively alleviate the condition of patients with premature ovarian failure.

Efficacy and influencing factors of sequential and concurrent chemoradiotherapy in the treatment of advanced non-small cell lung cancer in elderly patients / 中国医师进修杂志

Objective:To explore the efficacy of sequential and concurrent chemoradiotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) in the elderly, and to analyze the influencing factors of prognosis and outcome.Methods:The clinical data of 195 elderly patients with advanced NSCLC admitted to Beijing Shijingshan Hospitaland and Beijing Shijitan Hospital from March 2015 to March 2018 were retrospectively analyzed. They were divided into the concurrent chemoradiotherapy (100 cases) and the sequential chemoradiotherapy (95 cases) according to different chemoradiotherapy regiments. The short-term efficacy, 3-year survival, influencing factors of prognosis and toxic and adverse effects of the two groups were compared.Results:The objective response rate in the concurrent chemoradiotherapy group was significantly higher than that in the sequential chemoradiotherapy group: 61.00%(61/100) vs. 44.21%(42/95), there was statistically difference ( χ2 = 5.51, P<0.05). The 2-year and 3-year survival rate in the concurrent chemoradiotherapy group were 52.00% and 23.00%, which were significantly higher than those in the sequential chemoradiotherapy group: 32.60%, 11.60%, there were statistically differences ( P<0.05). Multivariate analysis results showed that smoking, Karnofsky score<70, TNM stage Ⅲb, short-term efficacy and treatment methods/sequential chemoradiotherapy were independent risk factors ( P<0.05). The incidence of radiation esophagitis, bone marrow suppression and lung function damage in the concurrent chemoradiotherapy group were higher than those in the sequential chemoradiotherapy group: 45.00%(45/100) vs. 27.37% (26/95), 36.00%(36/100) vs. 22.11%(21/95), 48.00%(48/100) vs. 26.32%(25/95), there were statistically differences ( χ2 = 6.54, 4.55, 9.78; P<0.05). Conclusions:Concurrent chemoradiotherapy can improve the short-term efficacy, and improve the 2-year and 3-year survival rates in advanced NSCLC in elderly patients, but the adverse effects are significantly enhanced.

A clinical research on relationship between sepsis-induced coagulopathy and prognosis in patients with sepsis / 中华急诊医学杂志

Objective:To evaluate the prognostic value of sepsis-induced coagulopathy (SIC) in patients with sepsis.Methods:From January 2019 to December 2021, patients with sepsis admitted to the Intensive Care Unit of our hospital were retrospectively classified into the SIC group and non-SIC group according to SIC diagnostic criteria. The baseline clinical data, severity score, total length of hospital stay, length of ICU stay and 28-day survival were compared between the two groups. Kaplan-Meier was used to compare the 28-day survival of patients with sepsis between the two groups. Cox proportional hazard regression model was employed to analyze the risk factors of prognosis in patients with sepsis.Results:Totally 274 patients with sepsis were included in the analysis, including 139 patients in the SIC group and 135 patients in the non-SIC group. The two groups were compared in the perspectives of the Platelet count (PLT), prothrombin time (PT) , procalcitonin (PCT), D dimer, hematocrit, red blood cell distribution width, hemoglobin, acute kidney injury (AKI), the use of continuous renal replacement treatment (CRRT), the use of vasoactive drugs, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHEⅡ) score were compared between the two groups and the difference were statistically different (all P<0.05). Kaplan-Meier analysis showed that the 28-day mortality rate in the SIC group was significantly higher than that in the non-SIC group (32.4% vs. 14.1%, P<0.05). COX proportional hazard model showed that SIC score ( HR= 2.17, 95% CI: 1.15-3.91, P<0.05), APACHEⅡ score ( HR= 1.13, 95% CI: 1.09-1.17, P<0.05) and the use of vasoactive drugs ( HR=3.66, 95% CI: 1.53-8.75, P<0.05) were independent influencing factors for 28-day death in patients with sepsis. Conclusions:Patients with sepsis and SIC have more severe disease and increased mortality risk. SIC score exhibits good clinical value in predicting the prognosis of patients with sepsis.

Evaluation of age-adjusted Charlson comorbidity index on prognosis and application timing of Shenfu injection in elderly patients with septic shock / 中华急诊医学杂志

Objective:To evaluate the value of age-adjusted Charlson comorbidity index (aCCI) in the clinical prognosis of sepsis and septic shock in the elderly, and to further explore the role of aCCI in evaluating the timing of Shenfu injection in elderly patients with septic shock.Methods:Clinical data of elderly patients with sepsis and septic shock in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1, 2019 to January 1, 2022 were retrospectively analyzed. With the median aCCI score of all samples as the cutoff value, the patients were divided into the low aCCI score group and high aCCI score group. The prognosis of elderly patients with septic shock and the application timing of Shenfu injection with aCCI score and sequential organ failure assessment (SOFA) were compared.Results:A total of 61 patients were included, including 31 patients in the high aCCI score group. The proportion of septic shock in elderly sepsis patients was lower in the low aCCI score group ( P < 0.05). The aCCI score (95% CI: 1.229-2.615; P< 0.01) was more valuable than SOFA score (95% CI: 1.035-1.607; P< 0.05) in predicting septic shock in elderly patients with sepsis. The 28-day survival rate in the low aCCI score group was higher than that in the high aCCI score group ( P < 0.05). Both the SOFA score (95% CI: 1.010-1.364) and the aCCI score (95% CI: 1.072-10.501) were independent factors affecting the 28-day survival rate. The use of Shenfu injection was associated with 28-day survival outcome in elderly patients with septic shock (95% CI: 0.012-0.788; P < 0.05). Conclusions:aCCI score is more effective than SOFA score in assessing the risk of shock in elderly patients with septic shock, and has a certain predictive value for the survival and prognosis of elderly patients with sepsis. Shenfu injection may be beneficial to the survival and prognosis of elderly patients with septic shock, but it needs to be further verified by large-scale prospective studies.

Evaluation of an integrated teaching model of oral preclinical practice based on endodontic-restorative sequential treatment / 口腔疾病防治

Objective@#Evaluate the effect of an integrated teaching model of oral preclinical practice based on endodontic-restorative sequential treatment to provide a reference for the exploration of the teaching mode of the stomatology specialty. @* Methods @#This retrospective study was reviewed and approved by the Ethics Committee. The study was divided into 2 groups. There were 450 2018-grade and 2019-grade students in the discipline integration teaching method (DIT) group, and a preclinical practice course (root canal therapy and fixed prosthetic treatments were integrated into an endodontic-restorative sequential treatment) using the DIT method was applied. There were 443 2016-grade and 2017-grade students in the traditional teaching method (TT) group, and a TT preclinical practice course (root canal therapy and fixed prosthetic treatments training courses were taught separately) was applied. Both groups were taught by the same two teachers. The scores of clinical skills examination and treatment planning were compared between the two groups. In addition, students in the two groups were asked to complete the questionnaires about the teaching methods, and students in Group DIT and their teachers were asked to complete the questionnaires on their degree of satisfaction with the DIT method in the preclinical course. @*Results @# Students in the DIT group had an average score of 90.2 ± 4.16 in the practical skill evaluation, which was higher than that of the TT group (86.3±3.57) (P = 0.001). In the case analysis, 91.8% (413/450) of the students in the DIT group successfully planned the treatment, compared to a significantly lower rate in the TT group of 74.7% (331/443) (P = 0.001). The questionnaire results showed that recognition degrees of cultivated clinical thinking, improved indication analysis ability, improved operational skills, stimulated enthusiasm for learning, and improved autonomous learning were higher in the DIT group than in the TT group, and both teachers (2/2) and 98.4% (443/450) of students recognized the DIT method. @*Conclusions@#The DIT method significantly improved students’ learning quality and ability, proved effective in the endodontic-restorative sequential treatment practice course and was more acceptable to teachers and students. The DIT method is more effective than the TT method in improving students’ clinical thinking and operation ability.

Meta-analysis and trial sequential analysis of Compound Qinlan Oral Liquid in treatment of acute upper respiratory tract infection / 中国中药杂志

This study aims to evaluate the efficacy and safety of Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. Computer-based online searching of CNKI, VIP, SinoMed, Wanfang, ChiCTR, ClinicalTrials.gov, Cochrane Library, PubMed, EMbase, and Web of Science was performed to retrieve the randomized controlled trial(RCT) regarding Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. In addition, manual searching of gray literature was conducted. After two evaluators independently selected articles, extracted data, and evaluated the quality of methodology included in the studies, Meta-analysis was carried out in RevMan 5.4 and trial sequential analysis(TSA) in TSA 0.9.5.10 Beta. GRADE profiler 3.6.1 was employed to evaluate the evidence quality. A total of 21 RCTs were included in this study, involving 2 651 patients(1 330 patients in the observation group and 1 321 patients in the control group). Meta-analysis showed that compared with conventional western medicine alone, Compound Qinlan Oral liquid improved the total response rate(RR=1.15, 95%CI[1.12, 1.19], P<0.000 01) without increasing the incidence of adverse reactions(RR=0.77, 95%CI[0.47, 1.25], P=0.16). The results of subgroup analysis are described as follows:(1) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid improved the total response rate(RR=1.10, 95%CI[1.05, 1.14], P<0.000 01) and shortened the time to symptom relief(SMD=-0.76, 95%CI[-1.02,-0.51], P<0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=1.16, 95%CI[0.54, 2.47], P=0.71).(2) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid + conventional western medicine improved the total response rate(RR=1.20, 95%CI[1.15, 1.25], P<0.000 01), decreased traditional Chinese medicine(TCM) syndrome scores(MD=-0.58, 95%CI[-0.75,-0.41], P<0.000 01), shortened the time to symptom relief(SMD=-2.44, 95%CI[-3.09,-1.80], P<0.000 01) and physical sign improvement(MD=-2.57, 95%CI[-4.11,-1.04], P=0.001), lowered the serum levels of inflammatory cytokines(SMD=-2.16, 95%CI[-2.61,-1.70], P<0.000 01), improved respiratory function indicators(SMD=1.48, 95%CI[1.00, 1.96], P<0.000 01), and enhanced the humoral immunity(MD=0.94, 95%CI[0.69, 1.18], P<0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=0.57, 95%CI[0.29, 1.09], P=0.09). TSA showed that the cumulative Z curve of total response rate crossed the traditional threshold and TSA threshold, further confirming the clinical efficacy of Compound Qinlan Oral Liquid. The GRADE graded the evidence of the above outcome indicators as low or extremely low, and yielded weak recommendation. Compared with conventional western medicine alone, Compound Qinlan Oral Liquid can improve the total effective rate and reduce the time to symptom relief. The combination of Compound Qinlan Oral Liquid and conventional western medicine can improve the total response rate, mitigate the symptoms and improve the physical signs, reduce inflammation, and improve respiratory function and immunity of the patients with acute upper respiratory tract infection. In view of the limited number and quality of the included studies, the above conclusions still require high-quality RCT to provide evidence support.

Meta-analysis and trial sequential analysis of Chaihuang Granules in treatment of upper respiratory tract infection in children / 中国中药杂志

This study aimed to evaluate the efficacy and safety of Chaihuang Granules in the treatment of upper respiratory tract infection in children. The databases such as CNKI, Wanfang, VIP, SinoMed, Cochrane Library, PubMed, EMbase, Web of Science, Chinese Clinical Trial Registry, and ClinicalTrials.gov were searched for randomized controlled trial(RCT) of Chaihuang Granules for the treatment of upper respiratory tract infection in children, and supplemented by manual searching of gray literature. Two investigators independently screened the literature, extracted data, and assessed the methodological quality. Meta-analysis was performed using RevMan 5.4 software, trial sequential analysis was conducted using TSA 0.9.5.10 Beta software, and evidence quality evaluation was carried out using GRADE profiler 3.6.1 software. Eighteen RCTs involving 2 459 patients(1 262 in the treatment group and 1 197 in the control group) were included. Meta-analysis showed that compared with conventional therapy alone, Chaihuang Granules significantly improved the total effective rate(RR=1.18, 95%CI[1.15, 1.22], P<0.000 01), reduced the disappearance time of symptoms/signs(MD=-1.39, 95%CI[-1.66,-1.12], P<0.000 01), improved cytokine levels(MD=-2.40, 95%CI[-3.80,-1.00], P=0.000 8), improved humoral immune levels(MD=0.75, 95%CI[0.60, 0.90], P<0.000 01), and reduced the recurrence rate(MD=-2.11, 95%CI[-2.98,-1.25], P<0.000 01). However, the incidence of adverse reactions was not increased(RR=0.94, 95%CI[0.59, 1.49], P=0.78). Subgroup analysis showed that:(1) both Chaihuang Granules used alone(RR=1.19, 95%CI[1.11, 1.27], P<0.000 01) and in combination with other therapies(RR=1.18, 95%CI[1.14, 1.22], P<0.000 01) effectively improved the total effective rate.(2) In terms of symptoms/signs disappearance time, Chaihuang Granules effectively reduced the duration of fever(MD=-1.18, 95%CI[-1.78,-0.58], P=0.000 1), cough with sputum(MD=-1.82, 95%CI[-2.38,-1.25], P<0.000 01), cough(MD=-1.31, 95%CI[-1.89,-0.74], P<0.000 01), sore throat(MD=-1.57, 95%CI[-2.25,-0.89], P<0.000 01), and lung rales(MD=-1.49, 95%CI[-2.06,-0.92], P<0.000 01).(3) Regarding cytokine levels, Chaihuang Gra-nules effectively improved the levels of interleukin(IL)-2(MD=-0.94, 95%CI[-1.16,-0.72], P<0.000 01), IL-6(MD=-4.71, 95%CI[-6.39,-3.03], P<0.000 01), and tumor necrosis factor-α(TNF-α)(MD=-2.07, 95%CI[-2.43,-1.71], P<0.000 01).(4) In terms of cellular immune levels, Chaihuang Granules effectively improved the levels of CD3~+(MD=4.11, 95%CI[1.53, 6.69], P=0.002), CD4~+(MD=4.21, 95%CI[1.69, 6.73], P=0.001), CD8~+(MD=-2.65, 95%CI[-3.93,-1.37], P<0.000 1), and CD4~+/CD8~+(MD=0.25, 95%CI[0.14, 0.37], P<0.000 1).(5) In terms of humoral immune levels, Chaihuang Granules effectively improved the levels of IgA(MD=0.44, 95%CI[0.23, 0.64], P<0.000 1), IgM(MD=0.31, 95%CI[0.15, 0.46], P=0.000 1), and IgG(MD=2.02, 95%CI[1.60, 2.43], P<0.000 01). Trial sequential analysis showed that the cumulative Z-curve of the total effective rate crossed the boundary value, further confirming its clinical efficacy. The GRADE evidence quality evaluation showed that the evidence quality of the above outcome indicators was low or very low, and the recommendation strength was weak. Compared to conventional therapy alone, Chaihuang Granules can effectively improve the total effective rate of treatment, alle-viate symptoms and signs of upper respiratory tract infection in children, improve inflammatory conditions, enhance immune function, and reduce the recurrence rate. Due to the limited quality of the included studies, high-quality RCT is still needed to provide evidence support for the above conclusions.

Neurocircuitry of Predatory Hunting / 神经科学通报·英文版

Predatory hunting is an important type of innate behavior evolutionarily conserved across the animal kingdom. It is typically composed of a set of sequential actions, including prey search, pursuit, attack, and consumption. This behavior is subject to control by the nervous system. Early studies used toads as a model to probe the neuroethology of hunting, which led to the proposal of a sensory-triggered release mechanism for hunting actions. More recent studies have used genetically-trackable zebrafish and rodents and have made breakthrough discoveries in the neuroethology and neurocircuits underlying this behavior. Here, we review the sophisticated neurocircuitry involved in hunting and summarize the detailed mechanism for the circuitry to encode various aspects of hunting neuroethology, including sensory processing, sensorimotor transformation, motivation, and sequential encoding of hunting actions. We also discuss the overlapping brain circuits for hunting and feeding and point out the limitations of current studies. We propose that hunting is an ideal behavioral paradigm in which to study the neuroethology of motivated behaviors, which may shed new light on epidemic disorders, including binge-eating, obesity, and obsessive-compulsive disorders.

Comparing the Prognosticative Value of APACHE II and mSOFA Scores in Critically Ill Patients: A Prospective Study

Objective: Several predictive scoring systems measuring disease severity are used to predict outcomes, typically mortality, of critically ill patients in the intensive care unit (ICU). Two common validated predictive scoring systems include acute physiology and chronic health evaluation II (APACHE II) and modified sequential organ failure assessment score (mSOFA). To compare performance of APACHE II and mSOFA score in critically ill patients regarding the outcomes in the form of morbidity and mortality in ICU. Methods: This prospective observational clinical study was conducted on 100 patients over 6 months. For each patient, APACHE II score on day of admission and serial mSOFA scores on day 0, 3, 7 and 10 were calculated and compared. Results: The age of the non-survivors was significantly older than survivors was (57.1±11.76 and 54.28±15.16). [In our study we found that the mean length of ICU stay of non-survivors was (5.41±4.81) & survivors(8.63± 4.81) days.] In our study mortality rate was 40%.The APACHE II score with cut-off point of 23 demonstrated a sensitivity rate of 98.33% & specificity rate of 17.5%, accuracy of 66.00%. Serial mSOFA scores with cut-off of 11 on day0, day3, day7 better differentiated survivors from non-survivors with 98.3% sensitivity, 27.5% specificity and 70% accuracy. Conclusion: Both APACHE II and mSOFA scores can help ICU physicians as a significant predictive marker for mortality in critically ill patients. The serial measurement of mSOFA score in the first week is a better mortality predictor tool than APACHE II score in critically ill patients.

Immediately sequential bilateral cataract surgery in Down syndrome

The exponential increase in world population and average human lifespan is expected to result in geriatric population globally. The problem of preventable blindness due to cataract will increase manifold. Simultaneous Bilateral cataract surgery (SBCS) is a viable option in such subset of patients. Despite faster visual recovery, economic benefits to patients and health care providers, decreased risk of complications associated with General anaesthesia, there is significant resistance in accepting SBCS as a routine procedure. Bilateral endophthalmitis is the main deterrent in performing ISBCS. This case highlights successful ISBCS in 36 years old female patient with Down抯 syndrome.

INTERPRETATION AND ESTIMATION OF CONDITIONAL POWER IN INTERIM ANALYSES OF CLINICAL TRIALS: OFTEN IGNORED IN DECISION MAKING PROCESS

In group sequential trials, the interim results are more promising in the early termination of a trial either for efficacy or futility of the trial. This reduces the cost and time implications. Moreover, interim analyses play a key role to tackle the problem that arises due to adverse effects. In concern with the early stopping of trials, there are numerous stopping methods among them the Conditional power (CP) approach is best recommended. The CP approach provides the probability of getting significant results at the end of the study given the data observed so far. There are very few Indian studies that had incorporated the concept of CP and made decisions based on the results. This study popularises the CP approach detailing computing and its interpretation and is thereby facilitating clinical researchers to use this approach effectively. We have used real-time and hypothetical examples and illustrated the concept of CP under trend, CP under null, and CP under design. We suggest stopping the study for efficacy when the CP under null is greater than 80% and stopping the study for futility when CP under trend is less than 30%.