This study was aimed to establish the HPLC fingerprint ofPhyllanthus urinaria Linn and Phyllanthusamarus Linn, in order to provide evidences for the study on material basis. Analysis was performed on an INDUSTRIES Epic C18 120A (5μm, 250 mm × 4.6 mm) column eluted with the acetonitrile (A) - water (0.1% phosphoric acid, V/V) gradient system as mobile phase. The wavelength was 254 nm and the flow rate was 1mL·min-1. The column temperature was 30℃. The injection volume was 10 μL. The results showed that the HPLC fingerprint ofPhyllanthus urinaria L. andPhyllanthus amarus L. were established. It was concluded that the method was simple, accurate and reproducible. This study provids experimental data for rapid quality identification and comprehensive evaluation ofPhyllanthus urinaria L. andPhyllanthus amarus L..

【Objective】To explore the optimal conditions in fingerprinting (APHDF).【Methods】The human DNA fingerprints were detected by APHDF.A pair of short primers was used for amplification.The experimental conditions including template,Mg2+,deoxyribonucleotides,and parameters of cycle,were optimized.【Results】The template DNA should be abstracted freshly and the concentration should be ranged from 50～550 mg/L.The best concentration of Mg2+was 5.0 mmol/L.The deoxyribonucleotides concentration was optimal at 0.2 mmol/L.The PCR cycling parameters were as follows :The denaturing temperatures,annealing temperatures and extension temperatures were 94 ℃ and 90 ℃ for 30 s,43 ℃ and 48 ℃ for 40 s or 50 s,and 72 ℃ for 1 min or 80 s,respectively.【Conclusion】The optimal conditions of the experiment are obtained,with good reproducibility and high specificity.Therefore,this method can be widely applied in practice.

Objective:To explore the risk factors of thyroid nodules in diabetic patients and its correlation with Traditional Chinese Medicine (TCM) constitution.Methods:A Total of 213 cases of diabetic patients in Guang’anmen Hospital and Tangshan Hospital from January 2019 to August 2020 were choosen to do the questionnaire, with containly symptom and constitution. The patients were divided into diabetes with thyroid nodules group and diabetes without thyroid nodules group according to whether thyroid nodules were combined. We compared the clinical data characteristics of 2 groups, and used multi-factor logistic regression model to analyze the risk factors of diabetic patients with thyroid nodules and their correlation with TCM constitutions. Results:Diabetes patients aged from 50-80 years old [ OR=2.949, 95% CI (1.266-6.714)], females [ OR=3.736, 95% CI (1.823-1.541)], diabetes duration≥15 years [ OR=1.558, 95% CI (1.623-1.585)], elevated HbA1c [ OR=5.862, 95% CI (1.418-23.629)], elevated VLDL [ OR=2.851, 95% CI (1.597-6.824)], frequent insomnia [ OR=1.970, 95% CI (1.315-3.395)], Qi stagnation [ OR=4.357, 95% CI (2.634-8.377)], blood stasis [ OR=4.420, 95% CI (1.874-15.258)] are more likely to suffer from thyroid nodules ( P<0.05). Conclusion:Diabetic patients aged from 50-80 years old, females, diabetes duration≥15 years, elevated HbA1c, family history of thyroid nodules, frequent insomnia, and mood swings are more likely to develop thyroid nodules; qi stagnation and blood stasis are dangerous constitutions for diabetic patients with thyroid nodules.

Abstract The popularization of the use of electronic has become a global trend, and children are exposed to devices at younger ages. A large proportion of children and adolescents spend on screen time more than 2 h which is recommended in most guidelines. The paper reviews possible effects of screen time on physical and mental health, as well as mental disorders in children and adolescents. It is found that excessive screen time showed negative impacts on mental health, including depression, anxiety, mood disorder, social adaptational problems, behavioral disorders, self injurious behaviors, and health risk behaviors. Much attention has been paid on the association between excessive screen time and mental health of children and adolescents, while possible mechanisms and influencing factors are lacking. Effective intervention studies are needed to provide a basis for child and adolescent health promotion.

Objective:To evaluate the effectiveness of the information management system on the clinical application of special-grade antimicrobial.Methods:Using the established knowledge database, a computer program was designed and developed, which was embedded in the electronic medical record to intervene the clinical use of the special-grade antimicrobial since 2015. The basic information of all discharged patients from the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2020 were extracted from the HIS system, including the medical orders for antibiotics and the drug storehouse dispensing data.The trend analysis was carried out on the changes of the use rates and antibiotic use density (AUD) of the special-grade antimicrobials in the whole hospital and intensive care units (ICU). The data were processed and analyzed using SPSS 24.0.Results:From 2013 to 2015, except for meropenem and amphotericin B, the usage rate of all special-grade antimicrobials in the whole hospital showed an upward trend ( P<0.05). The proportion of special-grade antimicrobials used in the hospital increased year by year ( χ2=7 804.081, P<0.01). The total usage rate of special-grade antimicrobials in ICU showed an upward trend year by year ( χ2=67.028, P<0.01). Since the implementation of the special-grade antimicrobial information management system in 2015, the total use rate of special-grade antimicrobials in the hospital, the use rate of various antibiotics except linezolid, amphotericin B and posaconazole, and the proportion of special-grade antimicrobials used in the hospital have all shown a downward trend year by year ( P<0.01). The total usage rate and total AUD of special-grade antimicrobials in ICU showed a decreasing trend year by year ( χ2=343.514, P<0.01, β=-0.963, P=0.002). Conclusion:The information management system for special-grade antimicrobial can effectively reduce the utilization rate and AUD of most special-grade antibiotics in hospitalized patients including ICU, and has a good clinical application value in antimicrobial stewardship.

Objectives:the purpose of this study was to systematically evaluate the clinical value of cytokines in autoimmune diseases (AID). It was a kind of complex disease, and its pathogenesis involved cytokines, autoantibodies, immune cells and other immune factors. Especially some AID, such as Adult still′s disease (AOSD) and Takayasu arteritis(TA), had no specific biomarkers at present. This study was a retrospective case-control study.Methods:the data of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8(IL-8) and interleukin-10(IL-10) in 834 AID patients from January 2019 to August 2022 were collected, and the serum levels of those cytokines in 30 healthy controls (HC) were detected at the same time. And AOSD, TA, systemic lupus erythematosus (SLE) and Behcet′s syndrome (BS) were divided into active group and inactive group. In addition, we also made a subgroup analysis of two important organs involved in SLE (kidney and nervous system). GraphPad Prism 9 and R 4.2.2 software were used. Nonparametric tests (Kruskal-Wallis H test, Mann-Whitney U test) were used to compare the differences among groups, and Dunn′s method was used to correct the false positive caused by multiple tests. Results:To compare the level of IL-6 in each group, except Behcet syndrome (BS) group and antiphospholipid syndrome (APS) group, the serum IL-6 level of AID group was higher than that of HC group, with antineutrophil cytoplasmic antibodies associated vasculitis(AAV) [3.85(2.00,8.55) pg/ml], idiopathic inflammatory myopathies(IIM) [7.80(2.50,6.50)pg/ml], IgG4-related disease(IgG4RD) [3.65(2.08,12.83) pg/ml], rheumatoid arthritis (RA) [5.50(2.20,16.10) pg/ml], SLE[4.70(2.75,16.55) pg/ml], Sj?gren syndrome(SS) [3.20(2.00,8.90) pg/ml], systemic sclerosis(SSc) [2.70(2.00,8.90) pg/ml], TA[3.40 (2.00,6.50) pg/ml], other AID diseases[4.40(2.00,11.10) pg/ml], especially AOSD [15.20(2.10, 39.20) pg/ml]. After correction, the differences were statistically significant ( P c<0.05). At the same time, the levels of serum TNF-α [7.40(5.60,10.95) pg/ml]and IL-10 [5.00(5.00, 7.58) pg/ml] in AOSD group were significantly higher than those in HC group[7.15(5.93,8.00) pg/ml,5.00(5.00,5.00) pg/ml] after correction ( P c<0.05). At the same time, the levels of serum TNF-α and IL-10 in AOSD group were higher than those in HC group. The serum levels of IL-6 and IL-8 in patients with active AOSD, BS, SLE and TA were significantly higher than those in patients without active disease (all P<0.05). In addition, the level of serum IL-8 in lupus nephritis group was significantly higher than that in non-lupus nephritis group ( P<0.05). At the same time, the serum levels of IL-6, IL-8 and TNF-α in neuropsychiatric lupus erythematosus group were significantly higher than those in non-neuropsychiatric lupus erythematosus group ( P<0.05), but there was no significant difference in IL-10 between neuropsychiatric lupus group and non-neuropsychiatric lupus erythematosus group. Conclusions:there was a close relationship between AID and cytokines. At present, the change of serum IL-6 level was the most classic one in clinical routine.

To effectively play the guiding role of pathogenic diagnosis in the rational use of antibiotics, hospitals at all levels urgently need to establish an effective control system for clinical microbial specimen submission. In response to the common problems in medical institutions in China, such as the low rate of microbiological specimen submission before antibiotic treatment, unreasonable structure of microbiological specimens, and the majority of morning sputum and urine specimens collected for pathogen testing, the Second Affiliated Hospital of Zhejiang University School of Medicine has constructed a management system for clinical microbiological specimen submission using artificial intelligence technology. It used a built-in intelligent rule engine to implement full process control over the sampling and submission of microbiological specimens by doctors when prescribing antibiotics, urge doctors to implement the requirement of collecting samples before using antibiotics for treatment, and recommend priority the collection of sterile specimens. In addition, the hospital transformed the laboratory and testing process with the goal of receiving microbial samples 24 hours without interruption and inoculating in real-time. The informatization management system began to be applied throughout the hospital in December 2015. The average rate of microbial sample submission before the first therapeutic use of antibiotics from June 2016 to 2023 was 79.2%, an increase of 90.2 percentage points from 41.7% in June 2014 ( χ2=467.781, P<0.01). The structure of microbial specimens continued to be optimized, and the proportion of sterile specimens in all submitted specimens increased from 47.2% in 2014 to 49.9% in 2023 ( χ2=139.119, P<0.01). The proportion of morning sputum and morning urine specimens decreased from 65.2% and 60.6% in 2014 to 11.1% and 16.9% in 2023, respectively ( χ2 values were 19 787.434 and 4 346.664, respectively, P<0.01), providing a more reliable basis for pathogenic diagnosis in clinical practice and providing reference for improving the management of pathogenic specimen submission in medical institutions.

Objective To explore the value of shear wave elastography(SWE)in the early assessment of hepatic and renal fibrosis in patients with metabolic associated fatty liver disease(MAFLD).Methods A total of 52 MAFLD patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from July 2023 to May 2024 were selected as MAFLD group,and 40 non-MAFLD patients treated during the same period were served as control group.General information,laboratory data and ultrasound data were collected and compared between two groups.The differences as well as the correlation of the indicators between two groups were compared.The value of SWE in hepatic fibrosis and renal fibrosis in MAFLD patients was assessed.Results Liver function indicators,uric acid and aspartate aminotransferase-to-platelet ratio index(APRI)in MAFLD group were higher than those in control group(P＜0.01);There were no statistically significant differences between two groups in fibrosis 4 index,estimated glomerular filtration rate,serum creatinine and blood urea nitrogen(P＞0.05).The brightness of the liver,liver-kidney ratio,and liver elasticity value were higher in MAFLD group than those in control group(P＜0.05);There was no significant difference in the elasticity value of the right renal cortex between two groups(P＞0.05).Liver elasticity values was positively correlated with alanine aminotransferase(ALT);The liver-kidney ratio was positively correlated with body mass index(BMI),ALT,aspartate aminotransferase,alkaline phosphatase,y-glutamyl transferase and APRI.No significant correlation was found between the right renal cortex elasticity and BMI,estimated glomerular filtration rate,serum creatinine,blood urea nitrogen,or serum uric acid.Conclusion SWE helps in early identification of liver hardness in the MAFLD patients.But the application of SWE in early renal fibrosis in the MAFLD patients needs further evaluation.

Objective To explore the erectile function preservational mechanism of Non-transecting urethroplasty(NTU) for posterior urethral stricture.Methods From May 2012 to September 2016,62 patients with posterior urethral stricture,who were treated with NTU,were enrolled in this study.The mean age was 37.5 years old,ranging 18-48 years old.The causes were pelvic fracture urethral injury in 53 cases and iatrogenic injury in 9 cases.Preoperative urethrography and urethroscopy revealed the strictures located in posterior urethra,which was at the distal of verumontanum.The mean length of stricture was 2.1 cm,ranging 0.5-2.5 cm.The average period between trauma and surgery was 6.4 months,ranging 3 months-2 years.All patients had no previous history of urethroplasty.Their sexual hormones were in normal level.Among those patients,the IIEF-5 scores were more than 12 and number of events during NPT test were more than twice.Finally,43 cases were underwent NTU and 19 cases accepted inferior pubectomy (IP)+ NTU.All patients had a general anesthesia.The bulbar urethra was mobilized dorsally from the tunica albuginea of the corpora cavernosa and then extended proximally up toward the perineal membrane.Scar tissue surrounding the urethra was excised and inferior pubectomy (IP) was performed as a supplemental technique to keep the suturing position without tension.The ventral hemi-circumference was then sutured with interrupted 4-0 polyglycolic sutures with tension-free anastomosis.The 18-Fr indwelling catheter was inserted.Result Average follow-up was 20.2 months,ranged from 12 to 36 months.In NTU group,NPT test revealed no significant difference in number of events (2.7 ± 0.7 vs.3.0 ± 1.0,P ＞ 0.05),duration of best episode [(16.4 ± 3.5) min vs.(16.4 ± 3.8) min,P ＞ 0.05)] or tip rigidity [(31.2 ± 4.7) ％ vs.(30.8 ± 3.5) ％,P ＞ 0.05)] between pre-and post-operation,respectively.The IIEF-5 score (19.7 ± 1.9 vs.20.4±2.1,P＜0.05)and Qmax[(8.7 ±4.0)ml/s vs.(25.5 ±4.7)ml/s,P＜0.05)] increased significant pre-and post-operation,respectively.In IP + NTU group,Qmax [(8.4 ± 4.4) ml/s vs.(23.1 ± 3.5)ml/s,P ＜ 0.05)] increased significant pre and post operation.The NPT test revealed slight decrease in number of events(2.3 ± 0.6 vs.1.6 ± 1.0,P ＜ 0.05),duration of best episode [(15.6 ± 2.4) min vs.(14.5±2.4)min,P＜0.05)] or tip rigidity [(29.8±3.0)％ vs.(25.6 ±7.1)％,P＜0.05)] between pre-and post-operation,respectively.However,the IIEF-5 scores (17.3 ± 1.6 vs.16.5 ± 2.1,P ＜ 0.05) didn't show significant difference pre-and post-operation.Stricture recurrence occurred in 3 patients,the success rate was 95.2％ (59/62) during 12 months following.Conclusion NTU is not only a safe and promising procedure for posterior urethral stricture less than 2.5cm,but also a new minimally invasive approach to preserve erectile function.

OBJECTIVE To mine adverse drug event （ADE） signals related to the pulmonary arterial hypertension （PAH） therapeutic drug macitentan， and to provide reference for safe clinical medication. METHODS Macitentan-related ADE reports were collected from the US FDA Adverse Event Reporting System （FAERS） database from the fourth quarter of 2013 to the third quarter of 2023. Data mining was conducted by using the reporting odds ratio （ROR） method and the comprehensive standard method established by the UK Medicines and Healthcare Products Regulatory Agency （referred to as “MHRA method”） under the proportional imbalance approach. According to the systemic organ class （SOC） and preferred term （PT） stated in 26.0 edition of Medical Dictionary of Regulatory Activities， standardized coding of ADE names was performed， followed by the analysis of time to onset （TTO） and the Weibull shape parameter （WSP） test. RESULTS Overall， a total of 26 079 ADE reports were identified with macitentan as the primary suspect drug. These reports predominantly involved female patients （73.25%） and were concentrated in the age range of 18 to 65 years （42.39%）. The majority of reports originated from the US （84.42%）， with hospitalization or prolonged hospital stays （59.82%） being the most common in severe treatment outcome. A total of 269 ADE positive signals related to macitentan were identified. Among these， hypothyroidism， ADE related to renal injury such as the increase of serum creatinine and blood urea nitrogen， and ADE related to psychiatric disorders like apathy and despair were not included in the drug label. TTO analysis indicated that the majority of macitentan-related ADE signals occurred between 0-30 days after initial treatment （492 reports， 21.52%） and over 360 days （411 reports， 17.98%）. The results of WSP test showed that most of the top 20 reported ADE signals conformed to the characteristics of an early failure curve. CONCLUSIONS When clinically using macitentan in patients with PAH， attention should be given not only to the adverse reactions mentioned on the drug label but also to thyroid dysfunction， kidney dysfunction and mental disorder-related ADEs.