Object To select the optimum proportion of matrix f or the preparation process of Qingxin Sushi Tie (QST) by gelatia, gum tragacanth , glycerol, sodium acylate and Qingdai. Methods The process was studied by orthogonal test with visco sity, soft and hard measurement algefacient sentation, twinge sentation as detec tive marker. The quality of QST was comprehensively compared by the different pr oportion of matrix. Results The optimum proportion of matrix in QST was gelatia-gum tyagacanth-glycerol-sodium acylate-Qindai (8 0∶3 5∶ 20∶1 3∶3 0). Conclusion According to the optimum proportio n of matrix in QST, the QST with better quality can be prepared.

Objective To establish a method for the determination of indigo content in Qingxin Sushitie by HPLC. Methods At 30℃, HPLC was performed to determine indigo on ODS column(4.6?250 mm), the mobile phase was composed of methanol-acetonitrile-0.1mol/L ammonium acetate(60: 4: 36), flow rate was 1.0 mL/min; injection volume was 20 ?L and detection wavelength at 280 nm. Results The linearity of indigo was good within 0.44～6.60 ?g/mL (r=0.9991), the average recovery was 103.6% and RSD=1.11%. Conclusion This method is simple, sensitive and accurate, and can be used for quality control of Qingxin Sushitie.

Objective To summarize the first experience with ultrasound-guided percutaneous ab lation treatment (PAT) for recurrent hepatoblastoma (HB) after liver resection in children.Methods From August 2013 to April 2015,PAT was used to treat 6 children with a total of 9 recurrent HB,including 5 patients with 8 tumors in the liver and 1 patient with 1 tumor in the lung.The mean size of ablated tumors was (1.5 ± 0.8) cm,and the tumor size range was 0.7 cm to 3.1 cm.Results Four patients were performed percutaneous radiofrequency ablation (RFA) for recurrent HB;and 2 patients were performed percutaneous ethanol injection (PEI).Ablation success was achieved in all patients (6/6,100％).The complete ablation rate after the first ablation session was 88.9％ (8/9) on a tumor-by-tumor basis.Only 1 patient developed a fever with temperature ＞ 39 ℃;it was resolved by conservative therapy.During the follow-up period of 5-30 months,3 patients died to tumor progression.The 1-and 2-year overall survival rates after ablation were 83.3％ and 41.7％,respectively.Conclusions PAT is a safe and promising therapy for children with recurrent HB after liver resection,and further investigation in large-scale randomized clinical trials is required to determine its role in the treatment of this disease.

Objective To retrospectively compare the safety and local efficacy of multiple-electrode switching based radiofrequency ablation (RFA) and the conventional RFA in treating single early-stage hepatocellular carcinoma (HCC).Methods A total of 82 patients with single early-stage HCC received either RFA with a multiple-electrode switching system (n =43) or conventional RFA (n =39) as the first-line treatment.The rate of initial local complete response,major complications and local tumor progression (LTP) were compared between two groups.Results The total ablation time was significantly shorter in the switching-RFA group [(16.7 ± 3.4) mins] than in the conventional RFA group [(29.8 ± 10.4) mins] (P ＜ 0.05).The rate of initial local complete response was 100％ (43/43) in the switching-RFA group and 94.9％ (37/39) in the conventional RFA group (P ＞0.05).After a mean follow-up period of (26.4 ± 21.8)months (ranging 3.0-91.6 months),the rates of LTP in the switching-RFA group and conventional RFA group were 16.3％ (7/43) and 17.9％ (7/39),respectively.The LTP rates in two groups were 16.1％ versus 11.2％ atyear1,and20.5％ versus 20.6％ at year2 (P=0.666).Conclusions The multiple-electrode switching based RFA is safe and effective with shorter ablation time in treating single early-stage hepatocellular carcinoma.

Objective:To analyze the operation efficiency of hospitals in 31 provinces in China from 2009 to 2019 based on the three-stage data envelopmeni analysis(DEA) model, for references to improve the operation efficiency of hospitals in China and promote the high-quality development of public hospitals.Methods:The data came from such sources as China health statistics yearbook and China general hospital ranking list of Fudan university.The number of hospitals, health technicians and beds in 31 provinces of China from 2009 to 2019 were used as input indicators, while that of hospital patients, discharged patients, hospitalized patients, reputational scoring of superior specialties and academic scoring of scientific research were used as output indicators.Government health expenditure, per capita GDP, population density and the proportion of tertiary hospitals were used as environmental variables.The three-stage DEA model was used to calculate the hospital operation efficiency and scale reward.Results:The environmental variables affected the operation efficiency of hospitals in China( P<0.05). After removing the impact, the average of comprehensive efficiency, pure technical efficiency and scale efficiency of hospitals in 31 provinces from 2009 to 2019 were 0.703, 0.961 and 0.726, respectively.Among them, the scale benefit of hospitals in 4 provinces remained unchanged, while those in 26 provinces increased progressively and 1 province decreased progressively. Conclusions:Pure technical efficiency could be the main factor to improve the operation efficiency of hospitals in China, while the low scale efficiency will affect the improvement of the operation efficiency of hospitals.The scale efficiency of hospitals in most provinces had great room for improvement.In order to improve the overall hospital operation efficiency in China, the authors suggested to expand hospital scale based on the precondition of quality, promote balanced distribution of high-quality medical resources, and play the positive role of the social, economic and environment variables.

Objective To investigate the effects of histone deacetylase inhibitors trichostatin A (TSA) on acute lung injury in septic mice.Methods Septic mice model was induced by cecal ligation and puncture(CLP).Ninty male BALB/c mice of clean grade were randomly(random number) divided into six groups(n=15),namely sham operation group,CLP group,CLP+DMSO group,CLP+TSA 1 mg group,CLP+TSA 5 mg group,and CLP+TSA 10 mg group.TSA(1 mg/kg,5 mg/kg,10 mg/kg) was administrated 12 hours before operation by intraperitoneal injection.And mice in sham group were only treated with laparotomy without CLP,and 24 h later,all survived mice were sacrificed to obtain specimens.ELISA method was employed to detect the concentrations of TNF-α and IL-1β in BALF.The lung wet/dry ratio was calculated.Histopathology changes of lung tissues were observed under light microscope.Lung tissue cell apoptosis was detected by TUNEL method.Caspase-3,Caspase-9 and CytC were assayed by Western blotting.The survival rate of mice in each group was calculated by additional 120 mice.Data were analyzed by SPSS 23.0.Statistical analyses were performed using independent sample t-test to compare between two groups or one-way analysis of variance test to compare among muhiple groups.The survival rate of mice was analyzed by univariate analysis using log-rank test.Results The lung W/D(P=0.021),the concentrations of TNF-α(P=0.000 1)and IL-1β(P=0.000 6)in BALF,puhnonary pathological change(P=0.001 6),lung tissue cell apoptotic index(P=0.000 9),the levels of apoptosis proteins (P＜0.05) in CLP group were higher than those in sham group,while survival rate (P=0.000 1) in CLP groups was lower than that in sham group.Compared with DMSO,the TSA significantly reduced the lung W/D,the levels of TNF-α.IL-1β in BALF,pathologic changes of lung tissue,lung tissue cell apoptotic index and the levels of apoptosis proteins in septic mice(P＜0.05).The increase in survival rate (P=0.007 2) associated with TSA(10 mg/kg)administration.Conclusion TSA exerts protective effects through attenuating pro-inflammatory cytokines and lung tissue cell apoptosis in sepsis induced acute lung injury in mice.

Objective To explore the antioxidant mechanism ofhistone deacetylase 2 (HDAC2) regulating Nrf 2 acetylation in lipopolysaccharide (LPS)-induced type Ⅱ alveolar epithelial cell injury.Methods The experiment was divided into two parts.The first part was the routine culture of type Ⅱ alveolar epithelial cells of mice.The cells were stimulated with different concentrations of LPS (10 ng/ mL,100 ng/mL and 1 000 ng/mL).CCK-8 was used to detect the cell activity at 0 h,6 h,12 h,24 h and 48 h,respectively.The second part:Alveolar epithelial cells of type Ⅱ were cultured and divided into the normal control group (control group),LPS group,HDAC2 lentivirus interference group (siRNA-HDAC2 group) and HDAC2 lentivirus overexpression group (LV-HDAC2 group).The expression of HDAC2 and Nrf2 were detected by Western blot,the acetylation of Nrf2 was detected by immunoprecipitation,and the stability of nrf2 was detected after actinidone action.The activity of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by chemical colorimetry.SPSS 23.0 statistical software was used.LSD-t test was used for comparison between two groups,and one-way ANOVA test was used for comparison among multiple groups.Results Compared with the control group,the expression of HDAC2 protein in the LPS group increased (t=5.974,P=0.027),the acetylation level of Nrf2 decreased (t=7.223,P=0.002),the Nrf2 protein level increased (t=2.929,P=0.043),the protein stability of Nrf2 increased,the SOD activity decreased (t=121,P＜0.01),and the MDA content increased (t=10.45,P=0.000 5).Compared with the LPS group,Nrf2 acetylation level decreased in the LV-HDAC2 group (t=1 1.29,P=0.000 4),Nrf2 protein expression increased (t=3.194,P=0.033),Nrf2 protein stability increased,SOD activity increased (t=4.678,P=0.009),and MDA content decreased in the LV-HDAC2 group (t=5.417,P=0.005 6).While the opposite trend was observed in the siRNA-HDAC2 group.Conclusion After LPS stimulation,oxidative stress of type Ⅱ alveolar epithelial cells was aggravated.HDAC2 could decrease the level of Nrf2 acetylation,increase the expression of Nrf2 protein,and alleviate LPS-induced oxidative stress.

Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.