Objective To investigate the effects and mechanism of huoxuexiaoying tablet on experimental goiter of rats. Methods The rats were randomly divided into six groups: the control, the model control group, huoxuexiaoying tablet at different doses,and the sodium levothyroxine group ( Euthyrox group) . Except for the rats in the control,the rats in other groups were given with propylthiouracil (20 mg·kg-1 ·d-1 ) by intragastric ( i. g. ) administration every day for 60 days. Meanwhile, some rats were treated with huoxuexiaoying tablet at low (4. 4 g·kg-1·d-1),middle (8. 8 g·kg-1·d-1) and high dose (17. 6 g·kg-1 ·d-1 ) orally,and those in the Euthyrox group were given with 7. 8μg·kg-1 ·d-1 Euthyrox by i. g. administration. The rats in the control group were administrated with the same volume of saline (N. S). After 60 days of treatment,the rats were sacrificed,the organ indexes of thyroid and pituitary and the levels of free triiodothyronine ( FT3 )、free thyroxin ( FT4 ) and thyroid stimulating hormone(TSH) in serum,were tested. The expression of basic fibroblast growth factor(bFGF),transforming growth factor-β( TGF-β) and B-cell lymphoma 2 gene ( Bcl-2 ) were examined by immunofluorescence. Results Compared with the model,organ indexes of thyroid were significantly reduced by huoxuexiaoying tablet at three doses (P<0. 05),but not for the pituitary (P>0. 05). The levels of FT3 and FT4 were in a elevating trend,but TSH decreased with no significance (P>0. 05). The morphological structure of thyroid was greatly improved by huoxuexiaoying tablet in comparison with the model. In which the gland dilated,thyroid follicular restored to moderate size,epithelia were cubic or flattened and follicular cavity filled with abundant glial. The expression of bFGF and Bcl-2 decreased significantly (P<0. 01) while TGF-β expression increased notably (P<0. 01). Conclusion Huoxuexiaoying tablet has a great anti-goiter effect,the mechanism of which may be related to promoting thyroid cells apoptosis and inhibiting thyroid cells proliferation.

Objective To investigate the significance of the combined detection of several serum tumor markers with high-risk human papillomavirus (HR-HPV) in the diagnosis of cervical cancer.Methods Chemiluminescent microparticle immunoassay(CMIA) was employed to measure the levels of serum CA125,CA19-9,SCCA and CEA in peripheral blood samples collected from 249 patients with cervical cancer,30 patients with cervix intraepithelial neoplasia(CIN),and 60 healthy controls.The levels of serum CA72-4,HE4 were measured by electrochemiluminescence immunoassay(ECLI).Flow-through hybridization and gene chip technology (HybriMax) was employed to measure the HPV genotypes in all the 339 cases of women.Results Serum CA72-4 level in the cervical cancer group [3.13 (2.25,7.63) ng/mL] was significantly higher than that in the C IN group [2.37 (1.98,6.25) ng/mL] and the control group [2.69 (2.35,3.35) ng/mL] (P =0.028;P =0.003).Serum CEA level in the cervical cancer group 3.08 (2.28,4.75) ng/mL was significantly higher than that in the CIN group [1.45 (1.00,1.83) ng/mL] and the control group [2.13 (1.45,2.67) ng/mL] (P =0.000;P =0.000).Serum CA 125 level in the cervical cancer group [24.4(20.30,44.15) U/mL] was significantly higher than that in the CIN group[12.85(7.90,16.23)U/mL] and the control group[12.33 (11.26,17.11) U/mL] (P =0.000;P =0.000).Serum CA19-9 level in the cervical cancer group[27.05(18.48,38.01) U/mL] was significantly higher than that in the CIN group[13.01 (8.79,17.12) U/mL] and the control group[12.83 (10.89,17.93) U/mL] (P =0.000;P =0.000).Serum SCCA level in the cervical cancer group [1.7 (0.90,4.75) ng/mL] was significantly higher than that in CIN group [0.8 (0.60,1.10) ng/mL] and the control group [0.6 (0.50,0.70) ng/mL] (P =0.000;P =0.000).However,there was no significant difference of HE-4 among three groups (P ＞ 0.05).The HR-HPV infection rates in the cervical cancer (92.4％) and CIN patients (90.0％) were significantly higher than that in controls (15.0％)(x2 =46.875,P =0.000;x2 =165.178,P =0.000).In the cervical cancer patients,the levels of serum tumor marker was associated with Federation International of Gynecology and Obstetrics (FIGO) stage (P ＜ 0.05).ROC curves showed HR-HPV was the most sensitive in the diagnosis of cervical cancer.The sensitivity of the diagnosis of cervical cancer by serum tumor markers combined with HR-HPV(97.99％) was significantly higher than that of single marker,CA724 25.30％,CEA 20.89％,CA125 27.71％,CA199 24.90％,SCCA 52.61％,HPV 92.37％ (x2 =278.237,P =0.000;x2 =307.036,P =0.000;x2 =263.348,P =0.000;x2 =280.769,P =0.000;x2 =137.864,P =0.000;x2 =8.580,P =0.003).Conclusion Serum tumor markers combined with HR-HPV check can improve the detection rate of cervical cancer and has important clinical value.

Objective To compare blood pressure control in community hypertensive patients with different management methods.Methods Two neighborhood committees in a community of Pudong were selected as study area using cluster sampling method.A total of 5 166 residents aged ≥35 y were screened for blood pressure; the subjects with high blood pressure and had antihypertensive medication in last 6 months were included,and patients with secondary hypertension was excluded.The patients who entered community hypertension management program and got medication from community were included in community group; those who did not enter in community management program and/or not get medication from community were included in non-community group.Self-designed questionnaire was used for investigation.The medication compliance,awareness of hypertension risk factors and high blood pressure control were compared between two groups.Results Among 5 166 residents 4 763 were surveyed for hypertension with a response rate of 92.2％ and hypertension prevalence rate of 23.2％ (1 105/4 763).Among 1 012 patients with drug treatment for more than 6 months,there were 878 cases in community (86.8％) and 134 cases (13.2％) in non-community group.There were no significant differences in gender,age,education,working condition between community group and non-community group (P ＞ 0.05).44.3％ (389/878) patients in community group had a history of high blood pressure ＞ 10 y and that was 56.7％ (76/134) in non-community group (P =0.011) ; 28.6％ (251/878) patients in community group were at high risk for risk stratification and that in non-community group was 47.8％ (64/134) (P ＜0.001).The awareness of hypertension risk factors in community group and non-community group was 83.9％ and 95.5％,respectively (P ＜ 0.001).The medication compliance and blood pressure control rates in two groups were 93.2 ％ and 84.3 ％ (P ＜ 0.001),68.6％ and 51.5 ％,respectively (P ＜ 0.001).Conclusion The outcomes of hypertension management in terms of medication compliance and blood pressure control in community group are better than those in non-community group.

Objective To investigate the changes of CD4+ CD25+ CD127low regulatory T cells (Treg) in peripheral blood samples collected from the patients with cervical cancer and its clinical signifi -cance , and to evaluate the correlations between Treg cells and the infection of high-risk human papillomavir-us ( HR-HPV) .Methods Flow cytometry analysis was performed to measure the percentages of CD4+ CD25+ CD127low Treg cells among CD4+T cells in peripheral blood samples collected from 249 patients with cervical cancer , 30 patients with cervix intraepithelial neoplasia ( CIN) and 60 healthy subjects .The corre-lations between the levels of Treg cells and the clinicopathological features of cervical cancer were analyzed . Flow-through hybridization and gene chip technology ( HybriMax) were used to analyze the genotypes of HPV strains isolated from the 339 subjects.The correlations between Treg cells and HR-HPV infection were ana-lyzed.Results Compared with the healthy subjects , the patients with cervical cancer or CIN showed higher percentages of CD4+ CD25+ CD127low Treg cells and rates of HR-HPV infection (P<0.01).The percentages of CD4+ CD25+ CD127low Treg cells in patients with cervical cancer were significantly correlated with the sta-ges of cervical cancer , which was staged by the Federation International of Gynecology and Obstetrics (FIGO) staging system,and the degrees of differentiation (P<0.05).The percentages of CD4+ CD25+ CD127low Treg cells in the peripheral blood of patients with positive HR-HPV were significantly higher than those in patients without HR-HPV infection (P<0.01).Conclusion The CD4+ CD25+ CD127low Treg cells in peripheral blood might play an important role in the oncogenesis and development of cervical carcinoma , thus it could be used as a potential marker for the evaluation of disease progression .Moreover , the CD4+ CD25+ CD127low Treg cells were closely related to the HR-HPV infection.

Objective To investigate the changes of CD 4+CD25+CD127 low regulatory T ( Treg ) cells in peripheral blood samples from patients with lung cancer and their correlation with clinicopathologic features of lung cancer .Methods Flow cytometry was used to measure the percentages of CD 4, CD8, nat-ural killer ( NK) and Treg cells in peripheral blood samples collected from 160 patients with lung cancer and 60 healthy subjects .The correlations between the levels of Treg cells and clinicopathologic features of lung cancer were analyzed .The percentages of Treg cells in 60 patients with lung cancer before and after surgery were compared .Results The percentages of CD 4+and NK cells and the ratios of CD 4+/CD8+cells in pa-tients with lung cancer were significantly lower than those in healthy control , while the percentages of Treg cells in patients with lung cancer were decreased as compared with those in healthy subjects .The percenta-ges of Treg cells in patients with advanced cancer were significantly higher than those in patients at early stage (P<0.05), which dropped significantly after surgery (P<0.01).Conclusion The results of this study indicated that Treg cells in patients with lung cancer might inhibit antitumor immune responses and correlate with the progression of cancer .It would be worthwhile to check Treg cells in patients with lung cancer for monitoring the prognosis and treatment effects .

Objective:To analyze the epidemiological characteristics, diagnosis and treatment of malaria in the peacekeeping mission area of the Democratic Republic of the Congo (DRC), and to evaluate the efficacy of artemisinin based combination therapy (ACT), to provide clinical basis for the diagnosis and treatment of malaria.Methods:The clinical data of malaria-infected peacekeepers admitted to the Chinese Secondary Hospital of the United Nations Stabilization Mission in DRC (MONUSCO) from January 2014 to September 2020 were collected, and the general information, incidence characteristics, treatment and clinical outcomes of the patients were retrospectively analyzed.Results:From January 2014 to September 2020, 362 peacekeepers were hospitalized with malaria, the average annual incidence case was 54 cases per year, and the annual incidence was 9.5/1 000, with a median of 2.5 days (1 - 9 days) from onset to diagnosis. Severe malaria accounted for 7.73% (28/362) and uncomplicated malaria accounted for 92.27% (334/362). The incidence rate was 37.57% (136/362) in the dry season (April to September) and 62.43% (226/362) in the rainy season (October to March of the following year). After ACT antimalarial treatment, all patients were cured clinically. Eight cases recurred and were cured clinically after drug conversion ACT retreatment.Conclusions:In the peacekeeping mission area of DRC, peacekeepers are generally susceptible to malaria. ACT has a high cure rate, safety and efficiency in clinical treatment.

Phage therapy is one of the most important tools for the treatment of infections with multi-drug resistant bacteria. Such phages are usually isolated from hospital effluents, however, no systematic study on the distribution of phages in hospital effluents has been conducted so far. The aim of this study was to isolate the corresponding phages of common pathogenic bacteria isolated in the clinic as hosts, so as to assess the ecological distribution of phages in hospital wastewater and to provide a reference for the isolation and application of phages of drug-resistant bacteria in the clinic. A cross-sectional study design was used in this study. The 125 pathogenic bacteria (belonging to 16 different strains) isolated from the clinical microbiology laboratory of Qilu Hospital of Shandong University from May to June 2023 were selected as the target strains, and the phages corresponding to these strains were isolated and purified from the hospital wastewater by using the double-layer plate sandwich method. At the same time, the distribution of pathogenic bacteria in the same batch of wastewater was analyzed with the help of mNGS sequencing technology, so as to preliminarily investigate the abundance correspondence between pathogenic bacteria and phages in wastewater. The results showed that a total of 56 phage strains were isolated from 125 clinical pathogens as hosts, corresponding to six pathogens, including Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. All six pathogenic bacteria contained strains with different degrees of drug resistance, with a higher percentage of multi-drug resistant strains in A. baumannii, Escherichia coli and P. aeruginosa. The phage acquisition rates of these six pathogens were, in descending order, Escherichia coli (80%), Stenotrophomonas maltophilia (75%), Pseudomonas aeruginosa (70%), Klebsiella pneumoniae (66.67%), Acinetobacter baumannii (36.36%) and Staphylococcus aureus (12.5%). Preliminary mNGS sequencing results showed that the pathogenic bacteria with higher abundance in the batch of effluent were Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, Acinetobacter baumannii, Klebsiella aerogenes, Klebsiella michiganensis and Pseudomonas aeruginosa. In conclusion, phages of most common clinical Gram-negative pathogens were isolated from hospital wastewater with high isolation rates; however, phages of Gram-positive pathogens were isolated at lower rates, and only phages corresponding to Staphylococcus aureus were isolated in this study. The corresponding mNGS sequencing results showed that the distribution of Gram-negative pathogens in sewage may had a positive correlation with the ecological distribution of phages.

Phage therapy is one of the most important tools for the treatment of infections with multi-drug resistant bacteria. Such phages are usually isolated from hospital effluents, however, no systematic study on the distribution of phages in hospital effluents has been conducted so far. The aim of this study was to isolate the corresponding phages of common pathogenic bacteria isolated in the clinic as hosts, so as to assess the ecological distribution of phages in hospital wastewater and to provide a reference for the isolation and application of phages of drug-resistant bacteria in the clinic. A cross-sectional study design was used in this study. The 125 pathogenic bacteria (belonging to 16 different strains) isolated from the clinical microbiology laboratory of Qilu Hospital of Shandong University from May to June 2023 were selected as the target strains, and the phages corresponding to these strains were isolated and purified from the hospital wastewater by using the double-layer plate sandwich method. At the same time, the distribution of pathogenic bacteria in the same batch of wastewater was analyzed with the help of mNGS sequencing technology, so as to preliminarily investigate the abundance correspondence between pathogenic bacteria and phages in wastewater. The results showed that a total of 56 phage strains were isolated from 125 clinical pathogens as hosts, corresponding to six pathogens, including Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. All six pathogenic bacteria contained strains with different degrees of drug resistance, with a higher percentage of multi-drug resistant strains in A. baumannii, Escherichia coli and P. aeruginosa. The phage acquisition rates of these six pathogens were, in descending order, Escherichia coli (80%), Stenotrophomonas maltophilia (75%), Pseudomonas aeruginosa (70%), Klebsiella pneumoniae (66.67%), Acinetobacter baumannii (36.36%) and Staphylococcus aureus (12.5%). Preliminary mNGS sequencing results showed that the pathogenic bacteria with higher abundance in the batch of effluent were Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, Acinetobacter baumannii, Klebsiella aerogenes, Klebsiella michiganensis and Pseudomonas aeruginosa. In conclusion, phages of most common clinical Gram-negative pathogens were isolated from hospital wastewater with high isolation rates; however, phages of Gram-positive pathogens were isolated at lower rates, and only phages corresponding to Staphylococcus aureus were isolated in this study. The corresponding mNGS sequencing results showed that the distribution of Gram-negative pathogens in sewage may had a positive correlation with the ecological distribution of phages.

Objective To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM).Methods This was a 26-week,randomized,open-label,parallel-group,treat-to-target trial in 560 Chinese subjects with T2DM (men/women:274/263,mean age 56 years,mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs).Subjects were randomized 2:1 to once-daily IDeg (373 subjects) or IGlar(187 subjects),both in combination with metformin.The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks.Results Mean HbA1c decreased from 8.2％ in both groups to 6.9％ in IDeg and 7.0％ in IGlar,respectively.Estimated treatment difference (ETD) of IDegIGlar in change from baseline was-0.10％ points (95％ CI-0.25-0.05).The proportion of subjects achieving HbA1c ＜ 7.0％ was 56.3％ and 49.7％ with IDeg and IGlar,respectively [estimated odds ratio of IDeg/IGlar:1.26 (95 ％ CI 0.88-1.82)].Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar,respectively [estimated rateratio of IDeg/IGlar 0.69 (95％ CI 0.46-1.03),and 0.43 (95％ CI 0.19-0.97)].No differences in other safety parameters were found between the two groups.Conclusions IDeg was non-inferior to IGlar in terms of glycaemic control,and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia.IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment.Clinical trail registration Clinicaltrials.gov,NCT01849289.

Objective:To evaluate the clinical factors affecting the probability of malignant micro-sized (≤10 mm) solitary pulmonary nodules (≤10 mm, micro-sized SPN), and established a clinical prediction model. Methods:Medical records from 102 patients with a pathological diagnosis of micro-sized SPN (Group A), established between June 2012 and March 2014, were reviewed. Clinical data were collected to evaluate the independent predictors of malignant micro-sized SPN using single factor analysis and Logistic regression analysis. A clinical prediction model was subsequently created. Receiver-operating characteristic (ROC) curves were constructed using the prediction model. Between January 2015 and August 2017, data from an additional 10 patients enrolled from January 2015 to August 2017 from Jinhua Guangfu Hospital (Group B) with a pathological y diagnosed micro-sized SPN were used to validate this clinical prediction model. The model was also compared with the Mayo Clinic Model. Results:Median age of 102 patients (Group A) was 55.31±10.77 years old. There were 75.5％malignant nodules and 24.5％benign ones. Logistic regression analysis identified six clinical characteristics (no symptoms, upper lobe, diameter>5 mm, no clear border, not irregular round, no calcification) as independent predictors of malignancy in patients with micro-sized SPN. The area under the ROC curve for our model was 0.922 (95％CI:0.857-0.986). In our model, the diagnosis sensitivity and specificity were 88.3％and 84.0％, respectively. The test power of the model was better compared with the Mayo Clinic Model. Conclusions:In this study, we had found the independent predictors of malignant micro-sized SPN, and developed a prediction model that could accurately identify malignant micro-sized SPN in patients.