AIM To investigate the effect of Supplemented Buyang Huanwu Decoction (Astragali Radix,Angelica tail,Paeoniae Radix rubra,etc.) on blood glucose in diabetic rats and its antioxidant activity.METHODS The diabetic rat model induced by streptozotocin (STZ) was established,with metformin as positive control group.After intragastric administration with Supplemented Buyang Huanwu Decoction,the fasting blood glucose,superoxide dismutase (SOD) activity and malondialdehyde (MDA) content in serum and tissues (heart,kidney and pancreas) in rats were detected.HPLC was used to determine the contents of antioxidant constituents (calycosin-7-O-β-D-glucoside and peoniflorin) in plasma,whose pharmacokinetic parameters were then calculated.RESULTS Compared with the model group,the hypoglycemic activity in the Supplemented Buyang Huanwu Decoction group was obvious (P ＜ 0.05),the SOD activity in serum and various issues (except for pancreas) was significantly enhanced,together with significantly reduced MDA level (P ＜ 0.05).The pharmacokinetic behavior of two constituents (calycosin-7-O-3-D-glucoside and peoniflorin) accorded with two-compartment open model,whose blood concentrations reached the highest within 50-70 min,and showed no obvious changes within 180-720 min.CONCLUSION Supplemented Buyang Huanwu Decoction can reduce the blood glucose in diabetic rats and improve the antioxidant activities in heart and kidney.The fast absorption and slow metabolism of calycosin-7-O-3-D-glucoside and peoniflorin in decoction are beneficial to related treatment.

OBJECTIVE To understand the related factors,the situation and dynamics of hospital infection in order to effectively prevent and control it.METHODS From 12306 cases of inpatients who had investigated retrospectively,706 cases were with nosocomial infection monitored from Jan to Dec 2006.RESULTS The hospital infection rate was 5.74% in 2006.The hematological disease and,cancer patients and the elderly,were the high-risk population.The main infection site was the respiratory tract.Fungi accounted for 21.35%,the top was the Candida albicans.CONCLUSIONS To strengthen the training of medical staff,to monitor the key departments of hematology and cancer and respiratory diseases and to attend the disease surveillance and rationally use of antibiotics are the effective measures to reduce hospital-acquired infections.

Objective To analyze the misdiagnosed cases of the nodular goiter (NG)in real-time contrast-enhanced ultrasound(CEUS),in order to improve the diagnostic accuracy of NG.Methods Two-hundred and sixty-five cases of NG CEUS images,especially the 48 nodules in 44 misdiagnosis cases,were retrospectively analyzed to find out the main reasons of the misdiagnosis.In addition,the factors which effected the results of CEUS such as size,number and calcification of NG nodules were summarized.Results There were 42 nodules misdiagnosed as thyroid cancer,5 nodules misdiagnosed as thyroid adenoma and 1 nodular goiter misdiagnosed as subacute thyroiditis in 874 nodular goiter cases.The misdiagnosis rate of nodular goiter was 5.49% (48/874)by the diagnostic criterion of homogeneous enhancement in CEUS.The differences size and calcification of nodules had a significant impact on CEUS.The misdiagnosis rate of the NG nodules with major diameter less than 10 mm was much higher than that of more than 10 mm,the misdiagnosis rate of NG nodules with coarse calcification was much higher than the situation of microcalcification(P <0.05).Conclusions Major diameter less than 10mm and coarse calcifications of NG nodular are the main factors which influence the results of CEUS.

Objective:To investigate the relationship between low vitamin D levels and the risk of Graves' disease.Methods:Computer was used to search PubMed, EMbase, China National Knowledge Infrastructure (CNKI), Wanfang Database (Wanfang Data) and China Biomedical Database (CBM). Relevant Chinese and English literatures were collected, including literatures of vitamin D, Graves' disease and autoimmune thyroid disease from the earliest publication time of the literature in the database to September 2019. Statistical software Stata 12.0 was used for Meta-analysis of the data. Heterogeneity test was conducted on the literature that met the inclusion criteria. According to the results, a random-effect model fixed-effect model was selected for comprehensive quantitative analysis. Standardized mean difference ( SMD) and 95% confidence interval ( CI) were calculated, and Egger's test was used to evaluate publication bias and sensitivity analysis. Results:A total of 29 literatures were included in the study, covering 2 281 patients with Graves' disease and 4 200 control population. Meta-analysis results showed: after the data were combined using a random-effects model, vitamin D levels in patients with Graves' disease were significantly lower than that in the control population ( SMD = - 0.90, 95% CI: - 1.14, - 0.66, P < 0.01﹚; heterogeneity analysis and Meta-regression analysis showed that the four factors of national development degree, geographical location, indicator measurement method and whether Graves' disease was primary were not the main source of heterogeneity. However, in developing countries or Asian, the vitamin D levels of patients with Graves' disease were significantly lower than that of the control population ( P < 0.01). In developed countries or Europe, the difference was not statistically significant ( P > 0.05). Sensitivity analysis and publication bias analysis showed that the results of this study had certain stability and reliability. Conclusion:Low vitamin D levels may increase the risk of Graves' disease.

Objective:To construct the forewarning model of drug shortage in Shanxi province, so as to realize the early prediction of drug shortage.Methods:According to the drug shortage of data of each monitoring station in Shanxi province, from the four dimensions of drug factors, policy attributes, supplier factors and demander factors, 14 factors were selected for grey correlation analysis, for example whether they were urgent drugs for women and children, shortage types, etc. The main factors affecting the degree of drug shortage were selected, and the early warning analysis model based on two-step cluster analysis method was established.Results:A total of six factors with the highest correlation with the degree of drug shortage were determined in this study, in order: whether they were urgent drugs for women and children, shortage types, low-price drugs, the number of moving annual total monitoring enterprises in sale in the current month, shortage reasons, and whether they were basic drugs. Based on the two-step cluster analysis, a model of drug shortage forewarning in Shanxi Province was established, which was divided into four optimal clusters and the warning level was determined.Conclusions:This study establishes the early warning model of drug shortage in Shanxi province, which is helpful to find the risk of drug shortage as soon as possible, objectively predict the risk level, and assist the drug regulatory department to realize layered implementation and collaborative response.

Objective:To conduct periodic revalidation of the 15 items and 43 terms autoverification rules of blood analysis after 1 year of application, analyze the application suitability and make the rules improved.Methods:Track the results of 528 010 blood analysis samples of our hospital from August 1, 2019 to January 31, 2020, and analyze the pass rate and interception rate of autoverification; 600 specimens in total were selected randomly for microscope examination, including 300 specimens which touched autoverification rules (1 012 items of autoverification rules) and were intercepted by autoverification and 300 specimens which untouched autoverification rules and were released by autoverification. The abnormal characteristics and unacceptable Delta check of the specimens also need to be concerned at the same time.The false negative rate and false positive rate, true negative rate, true positive rate and pass correct rate of autoverification were verified and compared with the rate of the second phase verification when the autoverification rule was established. The false negative rate, false positive rate, true negative rate and true positive rate of the Delta check rule which 54 716 specimens touched were calculated and compared with the second phase verification rate when the autoverification rule was established.The results of microscopic examination were used as the gold standard for the calculation of the rates, and P<0.05 was considered as a significant difference. The false positive and true positive of 1 012 autoverification rules were analyzed item by item.The false positive and true positive of 108 specimens which touched blast cell autoverification rule were analyzed terms by terms. The mean TAT and median TAT of 528 010 specimens and 193 750 outpatient specimens were calculated respectively, and the report percentages of 528 010 samples that TAT<30, 30-60　and>60 min were calculated respectively. Analyze and evaluate the application suitability of autoverification rules to juge whether they meet the needs of doctors and laboratory. The design process and the rules and application process of autoverification were optimized and improved.Results:The autoverification pass rate was 63.06% (332 971/528 010), the interception rate was 36.94% (195 039/528 010). The false negative rate was 1.00% (1/600), the false positive rate was 12.67% (76/600), the true negative rate was 49% (294/600), the true positive rate was 37.33% (224/600), and the correct rate was 98% (294/300). The pass rate, true negative rate, true positive rate and correct rate of the periodic reverification group were higher than the second phase verification group, the false negative rate and false positive rate were lower than that the second phase verification group. The false negative rate and true positive rate of the Delta check of periodic verification group were lower than that the second phase verification group, the false positive rate and true negative rate were higher than the second phase verification group, there were significant differences in the comparition results. The mean TAT of 528 010 specimens was25 min, and the median TAT was 22 min. The mean TAT of 193 750 outpatient specimens was 23 min, and the median TAT was 20 min. The report percentages of 528 010 samples that TAT<30 min, 30 min-60 min and>60 min were 83.30% (439 819/528 010), 8.00% (42 250/528 010) and 8.70% (45 941/528 010), respectively.Conclusion:The results of periodic revalidation of autoverification after 1 years application show that the 15 items and 43 terms autoverification rules of blood analysis could meet requirements about the accuracy and efficiency of the laboratory, and have a good suitability for application.

Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.

ObjectiveTo review the ancient and modern literature of Huanglian Ejiaotang and learn about the historical evolution and clinical application， thereby providing a theoretical basis for the modern application of the classical prescription. MethodLiterature in the Chinese Medical Classics Database was retrieved with "Huanglian Ejiaotang" as the keyword. In China National Knowledge Infrastructure （CNKI） and PubMed， "Huanglian Ejiaotang" in Chinese and English was used as the keyword to retrieve literature. The items and modern clinical application studies related to the prescription， medicine， dosage， syndrome， and treatment of Huanglian Ejiaotang were selected and recorded. The inclusion and exclusion criteria were used to screen out literature. The information about the dynasty， book title， function， and indication was integrated to understand the history， evolution， and clinical application of Huanglian Ejiaotang. ResultFinally， 89 ancient books were included with 111 items. Huanglian Ejiaotang was initially recorded in ZHANG Zhongjing's Treatise on Cold Damage and Miscellaneous Diseases in the Han dynasty. It was composed of five herbs， namely Coptidis Rhizoma， Scutellariae Radix， Paeoniae Radix Alba， Asini Corii Colla， and egg yolk. With the change of historical dynasties， the composition， origin basis， dosage， and preparation method of Huanglian Ejiaotang all changed， but the changes in the processing were not obvious， which was basically consistent with Treatise on Cold Damage and Miscellaneous Diseases. In addition， 48 studies were included to analyze the clinical application of Huanglian Ejiaotang， which was mainly used for insomnia， anxiety， depression， diabetes， and so on. ConclusionAccording to the ancient and modern literature， the origin basis， dosage， processing， decoction， administration， and other content of Huanglian Ejiaotang are consistent with Treatise on Cold Damage and Miscellaneous Diseases. The present clinical application has expanded the usage scale of the ancient record， which promotes the innovation and development of the classic prescription and provides references for later research， development， and accurate application.

Objective To investigate the influencing factors for direct-acting antiviral agent (DAA) therapy failure in the treatment of hepatitis C by comparing baseline clinical data and resistance-associated substitution (RAS) in sequencing data between the patients with HCV RNA reactivation after DAA therapy and the patients with successful DAA treatment. Methods A total of 13 patients from multiple centers who failed DAA therapy from November 2019 to October 2021 were enrolled as treatment failure group, and sequencing was performed for their positive serum samples. A total of 51 patients with successful DAA treatment were enrolled as control group, and baseline clinical data and sequencing results were compared between the treatment failure group and the control group. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; univariate and multivariate logistic regression analyses were performed to calculate odds ratio ( OR ) and investigate the influencing factors for treatment failure. Results All 12 patients with complete treatment data experienced recurrence within 1 year after the end of medication. The male patients with treatment failure had significantly higher baseline total bilirubin, direct bilirubin, and creatinine than their female counterparts ( Z =-2.517, -2.440, and -2.132, P =0.010, 0.010, and 0.038), and the patients with an age of ≤55 years ( OR =5.152, 95% confidence interval [ CI ]: 1.116-23.790, P =0.036) or genotype 3b ( OR =9.726, 95% CI : 1.325-71.398, P =0.025) had a higher probability of treatment failure. There were differences in the incidence rates of major RAS mutations on three gene fragments between the treatment failure group and the treatment success group, and the common RAS mutations detected in the treatment failure group were not detected in the treatment success group. Conclusion Age, genotype, and RAS in serum virus gene sequence are influencing factors for DAA treatment failure.