ObjectiveTo investigate the antitumor effect and mechanism of Guiqi Yiyuan ointment on Lewis lung cancer mice based on the extracellular regulatory protein kinase （ERK） signaling pathway. MethodsA Lewis lung cancer mouse model was established. Except for the blank group， the model mice were randomly divided into the model group， Guiqi Yiyuan ointment low， medium， and high dose groups， and the extracellular ERK1/2 inhibitor group， with 10 mice per group. The Guiqi Yiyuan ointment was administered by gavage at doses of 1.75， 3.5， 7.0 g·kg^-1·d^-1 for the low， medium， and high dose groups， respectively. The ERK1/2 inhibitor group was given the ERK1/2 inhibitor LY3214996 （100 mg·kg^-1·d^-1） by gavage. The treatment was administered for 14 consecutive days， after which samples were collected. Tumor histopathological changes were observed using hematoxylin-eosin （HE） staining. Transmission electron microscopy was used to observe ultrastructural changes in tumor cells. Immunofluorescence was performed to measure the phosphorylation of ERK1/2 （p-ERK1/2） and the expression of programmed cell death ligand-1 （PD-L1） in tumor tissues. Western blot and real-time quantitative polymerase chain reaction （Real-time PCR） were used to detect the expression of p-ERK1/2， PD-L1， the autophagy marker Beclin-1， the autophagic protein p62， and the microtubule-associated protein light chains LC3Ⅰ and LC3Ⅱ at both the protein and gene levels. ResultsCompared with the model group， the average tumor weight was significantly reduced in the low and medium dose groups of Guiqi Yiyuan ointment （P<0.05）， and markedly reduced in the high dose and inhibitor groups （P<0.01）. Tumor cells in all treatment groups became progressively irregular， with ruptured nuclei and expanded areas of cell disintegration and necrosis. The number of organellar ablations in tumor tissues increased， and the number of autophagic vesicles also increased in all groups. The mean fluorescence intensity of p-ERK1/2 and PD-L1 was reduced in the low and medium dose groups of Guiqi Yiyuan ointment （P<0.05）， and significantly reduced in the high dose and inhibitor groups （P<0.01）. The mRNA expression of ERK1/2， PD-L1， Beclin-1， and p62 was reduced in the medium dose group （P<0.05）， while LC3Ⅰ/Ⅱ mRNA expression was elevated （P<0.05）. In the high dose and inhibitor groups， mRNA expression of ERK1/2， PD-L1， Beclin-1， and p62 was significantly reduced （P<0.01）， while LC3Ⅰ/Ⅱ mRNA expression was significantly increased （P<0.01）. Protein expression of p-ERK1/2， PD-L1， Beclin-1， and p62 was reduced in the medium dose group （P<0.05）， and LC3Ⅰ/Ⅱ protein expression was elevated （P<0.05）. In the high dose and inhibitor groups， protein expression of p-ERK1/2， PD-L1， Beclin-1， and p62 was significantly reduced （P<0.01）， while LC3Ⅰ/Ⅱ protein expression was significantly elevated （P<0.01）. ConclusionGuiqi Yiyuan ointment may inhibit the activation of the ERK signaling pathway， downregulate the expression of p-ERK1/2， promote autophagic flux in tumor cells， and regulate the expression of PD-L1， thereby exerting an inhibitory effect on tumor growth in Lewis lung cancer mice.

Objective To explore the value of dynamic ultrasound combined with 3.0T MRI for diagnosing and typing synovial plica of knee joint.Methods Dynamic ultrasound and 3.0T MRI data of 100 patients with suspected synovial plica of knee joint were retrospectively analyzed.Taking the results of arthroscopy as standards,the efficacy of dynamic ultrasound and 3.0T MRI alone and their combination for diagnosing synovial plica of knee joint were evaluated and compared.The length and thickness of synovial plica of knee joint measured with dynamic ultrasound,3.0T MRI alone and their combination were compared with those of arthroscopy,and the consistencies of the location and classification of synovial plica of knee joint with arthroscopy were analyzed.Results Synovial plica was detected in 70 cases,including 11 cases of supropatellar synovial plica,15 cases of infrapatellar synovial plica,medial patellar in 30 cases and lateral patellar synovial plica in 14 cases,among them type A,B,C and D were classified in 9,35,23 and 3 cases,respectively.No significant difference of sensitivity was found between dynamic ultrasound and 3.0T MRI alone for diagnosing synovial plica of knee joint(P＞0.05),which were both lower than that of their combination(both P＜0.05).The length and thickness of knee synovial plica measured with dynamic ultrasound and 3.0T MRI alone were lower than those measured with their combination and arthroscopy(all P＜0.05),and there was no significant difference between the results of their combination and arthroscopy(both P＞0.05).Dynamic ultrasound,3.0T MRI alone and their combination had high consistency of location(Kappa=0.755,0.826,0.897)and classification of knee synovial plica with those of arthroscopy(Kappa=0.721,0.744,0.860).Conclusion Dynamic ultrasound combined with 3.0T MRI was valuable for diagnosing and typing of synovial plica of knee joint.

Objective To observe the clinical effect of nape needling combined with swallowing dysfunction therapeutic apparatus in the treatment of patients with swallowing dysfunction after cerebral infarction.Methods Eighty patients with swallowing dysfunction after cerebral infarction were randomly divided into observation group and control group,40 cases in each group.On the basis of routine treatment,the control group was treated with swallowing dysfunction therapeutic apparatus,and the observation group was treated with nape needling on the basis of the control group for 4 weeks.After 1 month of treatment,the clinical efficacy of the two groups was evaluated,and the changes of the water swallowing test(WST)score and the standard swallowing assessment(SS A)score were observed before and after treatment in the two groups,as well as the changes of the vertical and horizontal movement of the hyoid bone during swallowing in the two groups.The changes of serum substance P(SP)content were compared before and after treatment between the two groups.The safety and adverse reactions of the two groups were evaluated.Results(1)The total effective rate was 90.00％(36/40)in the observation group and 67.50％(27/40)in the control group.The curative effect of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,the WST and SSA scores of the two groups were significantly improved(P＜0.05),and the improvement of WST and SSA scores in the observation group was significantly superior to that in the control group,the difference was statistically significant(P＜0.05).(3)After treatment,the vertical and horizontal displacement of the hyoid bone in the two groups were significantly improved(P＜0.05),and the improvement of the vertical and horizontal displacement of the hyoid bone in the observation group was significantly superior to that in the control group,the difference was statistically significant(P＜0.05).(4)After treatment,the serum SP level of the two groups was significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the serum SP level,the difference was statistically significant(P＜0.05).(5)The total incidence of adverse reactions in the observation group was 5.00％(2/40);the control group was 25.00％(10/40);the incidence of adverse reactions in the observation group was significantly lower than that in the control group,the difference was statistically significant(P＜0.05).Conclusion Nape needling combined with swallowing dysfunction therapeutic apparatus in the treatment of swallowing dysfunction after cerebral infarction can significantly improve the swallowing function of patients,improve the serum SP level of patients,increase the displacement distance of hyoid bone,and reduce the incidence of adverse reactions.

Objective To explore the influencing factors of rational perioperative drug use,and to establish a rationality prediction model based on machine learning to assist pharmacists in prescription review.Methods A retrospective analysis was conducted on the perioperative prescription data of neurosurgery patients from a tertiary hospital and a central hospital in Shanxi Province between March 2021 and March 2023.Univariate analysis and multivariate Logistic regression were initially used to identify factors influencing rational drug use,followed by Lasso regression and multicollinearity analysis to select important variables.The data was split into a training set and test set at a ratio of 7∶3,and decision tree(DT),multi-layer perceptron(MLP),extreme gradient boosting(XGBoost),support vector machine(SVM),and random forest(RF)learning models were constructed.Results A total of 1 500 prescriptions were included,of which 668 were classified as rational and 832 as irrational.In both the training and test sets,the AUC values of the DT,XGBoost,and RF models exceeded 0.9.The DT model showed the highest sensitivity(0.81),while the RF model demonstrated the highest specificity(0.90).In the RF model,the number of comorbidities,preoperative waiting time,total hospitalization cost,prescribing physician's title,and adverse reaction occurrence negatively impacted prescription rationality,whereas the number of drugs,age,and administration route positively influenced rationality.Conclusion The machine learning-based rational drug use prediction model demonstrates strong predictive performance,effectively assisting pharmacists in prescription review and helping to reduce the incidence of irrational drug use.

OBJECTIVE To establish high performance liquid chromatography(HPLC)fingerprints of the extract of Fructus Li-gustri Lucidi-Ecliptae Herba and to identify the structure of its chemical constituents.METHODS The chromatographic separation was performed on ZORBAX Extend C18(250 mm×4.6 mm,5 μm)column with the mobile phase consisting of acetonitrile and 0.1%formic acid solution in gradient elution mode at a flow rate of 1.0 mL·min-1.The optimum column temperature was set at 35℃,the detection wavelength was 265 nm,and the injection volume was 10 μL.The HPLC fingerprints of 15 batches of herb pair from different origins were established.Then,similarity evaluation,cluster analysis,and orthogonal partial least squares discriminant analysis were carried out.The chemical structures of the constituents of the herb pair were identified based on the high-resolution mass spectrometry utilizing the UPLC-Q-Exactive Orbitrap MS in positive and negative-ion modes.RESULTS As a result,the similarity of the 15 bat-ches of samples varied from 0.865 to 0.992.A total of 16 common peaks were identified in the fingerprints,and 7 of them were identi-fied by comparision with the reference substances.Furthermore,55 chemical compounds were detected,and 7 of them were accurately identified based on the reference substances,and the chemical structures of the rest 48 components were temporarily speculated.CON-CLUSION The fingerprint method established in this study is simple,reliable,and reproducible,and can be further used for the quality control of Fructus Ligustri Lucidi-Ecliptae Herba herb pair.The developed UPLC-Q-Exactive Orbitrap MS method can be applied to identify the structures of chemical constituents in this herb pair and lay a foundation for further research.

OBJECTIVE To analyze the characteristics and influencing factors of medicine cost for orthopedic surgery patients in Shanxi province， and to provide reference for the rational management of medicine cost in orthopedic surgery patients. METHODS A retrospective analysis was conducted on the case information of 584 204 orthopedic surgery patients in Shanxi province from 2016 to 2021. Medicine cost was analyzed by year， region， hospital level， type of surgery and type of surgical incision. Single factor analysis and generalized linear regression model were used to analyze the influencing factors of total medicine cost， and structural equation model was used for verification. RESULTS The research findings indicated that joint replacement surgery （42.61%） and post-fracture external fixation surgery （12.60%） were the most common types of procedures. There was statistical significance in medicine cost for different surgical types among different regions and hospital levels （P＜0.05）. In the Jinzhong region， the total medicine cost for post-fracture external fixation surgery was the highest （[ 11 719.97±4 374.73） yuan]， while in tertiary grade A hospitals， the total medicine cost for post-fracture external fixation surgery was also the highest （[ 13 584.71±4 531.82） yuan]. Among class Ⅰ incision surgeries， the cost of antibiotics for post-fracture external fixation surgery was the highest （[ 1 176.25±341.42） yuan]. Generalized linear regression model revealed that hospital location， hospital level， gender， payment method， length of hospital stays， and surgical type were the independent influencing factors for total medicine cost （P＜0.05）. Structural equation model further disclosed that hospital level， payment type， and surgical type had significant effects on total medicine cost （P＜0.05）. CONCLUSIONS Attention should be paid to the high cost of antibiotics for class Ⅰ incision surgery， and further research on their rational use should be conducted.

Objective To explore the incidence and risk factors of perioperative ischemic stroke in non-cardiac and non-neurosurgical surgeries and its correlation with preoperative risk assessment of cerebrovascular events,so as to guide perioperative risk management.Methods A retrospective study was conducted on 40 patients aged≥18 years who underwent non-cardiac and non-neurosurgical surgeries and experienced perioperative ischemic stroke in the First Affiliated Hospital of Henan University of Science and Technology from January 2015 to January 2022,forming the stroke group.A control group of 160 patients without perioperative ischemic stroke was selected in a 1:4 case-control ratio,matched for gender,age,date of operation,and the surgeon.Clinical data and preoperative risk assessment of cerebrovascular events(including the single or combined application of head CT/MRI,transcranial Doppler ultrasound,carotid ultrasound,and neurological consultation)of the two groups of patients were collected and statistically analyzed.Multiple logistic regression analysis was used to identify risk factors associated with perioperative ischemic stroke.Results The incidence of perioperative ischemic stroke was 0.042%.Multiple logistic analysis results showed that hypertension(OR=7.858,95%CI 2.175-28.388,P=0.002),hyperlipidemia(OR=4.457,95%CI 1.320-15.049,P=0.016),renal insufficiency(OR=8.277,95%CI 1.480-46.282,P=0.016),and intraoperative hypotension(OR=3.862,95%CI 1.211-12.317,P=0.022)were independent risk factors for perioperative ischemic stroke in non-cardiac and non-neurological surgeries;preoperative cerebrovascular risk assessment(OR=0.130,95%CI 0.031-0.542,P=0.005)was a protective factor against it.Conclusions The incidence of perioperative ischemic stroke in non-cardiac and non-neurosurgical surgery is low but has a poor prognosis.Hypertension,hyperlipidemia,renal insufficiency,and postoperative hypotension are risk factors for perioperative ischemic stroke,while preoperative cerebrovascular event risk assessment is beneficial to reducing its incidence.

Objective To establish an evaluation system of pathogen detection rate of hospitalized patients before antimicrobial treatment based on process and outcome indicators,and study its application effect.Methods Hospi-talized patients with therapeutic antimicrobial treatment in a tertiary first-class hospital from July 2022 to June 2023 were selected as the study objects.Difference in process and outcome indicators were compared between before(Ju-ly-December 2022,control group)and after(January-June 2023,intervention group)the implementation of inter-vention in the evaluation system for pathogen detection rate of hospitalized patients before antimicrobial treatment.Results 41 577 and 27 052 hospitalized patients received therapeutic antimicrobial agents were included in the inter-vention group and control group,respectively.Pathogen detection rate and the accurate pathogen detection rate in the intervention group were both higher than those in the control group(74.2％vs 62.8％and 90.3％vs 82.5％,respectively),both with statistically significant differences(both P＜0.001).The goal achievement rate and im-provement rate for pathogen detection rate were 237.5％and 18.2％respectively,the goal achievement rate and im-provement rate for accurate pathogen detection rate were 104.0％and 9.5％respectively.For the process indica-tors,the conformity rate of detection and diagnosis,accurate collection rate,timely transfer rate,acceptance rate of pathogen specimens in the intervention group were all higher than those in the control group,differences were all statistically significant(all P＜0.001).For the outcome indicators,detection rates of targeted indicators and blood culture specimens,pathogen detection rate before treatment of restricted and special grade antimicrobial agent,as well as detection rate of sterile body fluid specimens in the intervention group were all higher than those in the con-trol group,with statistical significance(all P＜0.05).In addition,the positive rate of blood culture specimens in-creased from 18.5％before intervention to 21.7％after intervention,with statistically significant difference(P＜0.05).Conclusion The establishment of indicator evaluation system can improve the detection rate and accurate detection rate of pathogens before antimicrobial treatment,as well as the management quality and connotation of indicators.

Diacerein(DCN),an interleukin-1β(IL-1β)inhib-itor,has been clinically used for osteoarthritis.Chronic inflam-mation is considered as a causal factor of metabolic disorders,such as obesity and type 2 diabetes.Anti-inflammation therapy has emerged as an important strategy for improving the dysregu-lation of glucose and lipid metabolism.A series of domestic and international studies have shown that DCN regulates the disorders of glucose and lipid,which implies its potential application for the treatment of metabolic diseases.This paper summarized the effects and mechanisms of DCN on regulating glucose homeosta-sis and lipid metabolism.The mechanisms might involve the im-munomodulatory and anti-inflammatory action,the effect of anti-oxidative stress,the modulation of adipokine secretion,the regu-lation of programmed cell death,and the enhancement of insulin signaling transduction.These findings provide perspective for further development and application of DCN.

Objective To explore the inhibitory effect of Guiqi Yiyuan Ointment combined with cisplatin on Lewis lung cancer mice and its mechanism based on the lncRNA H19/miR-19b3p/FTH1 axis.Methods Totally 60 SPF grade male C57BL/6 mice were randomly selected as blank group,and Lewis lung cancer mouse model was replicated in the remaining 50 mice.The modeled mice were randomly divided into model group,cisplatin group,and TCM low-,medium-and high-dosage combined with cisplatin group,with 10 mice in each group.The cisplatin group was given intraperitoneal injection of cisplatin 5 mg/kg,while the TCM low-,medium-and high-dosage combined with cisplatin group were given Guiqi Yiyuan Ointment 1.75,3.5,7.0 g/kg by gavage combined with intraperitoneal injection of cisplatin 5 mg/kg,the blank group and model group were given equal volume of normal saline by gavage for 14 consecutive days.The general condition of mice was observed,the tumor mass of mice was measured,and the tumor inhibition rate,spleen index,and thymus index were calculated,HE staining was used to observe the pathological changes of tumor tissue,and the contents of malondialdehyde(MDA),reduced glutathione(GSH),hydrogen peroxide(H2O2),and ferrous ions(Fe2+)were detected in the tumor tissue,immunohistochemistry and Western blot were used to detect the expression of nuclear factor E2 related factor 2(Nrf2),glutathione peroxidase 4(GPX4),ferritin heavy chain 1(FTH1)and solute carrier family 7 member 11(SLC7A11)protein in tumor tissue,real time fluorescence quantitative PCR was used to detect the expression of lncRNA H19 and miR-19b3p mRNA in tumor tissue.Results Compared with the blank group,the body mass,spleen index and thymus index of mice in the model group were decreased(P<0.05).Compared with the model group,the mental state and tumor histopathological morphology of mice in each administration group were improved to different degrees,the tumor mass of mice was reduced(P<0.05),the spleen index and the thymus index of mice increased(P<0.05),tumor cell lysis,rupture,and decrease in quantity,the contents of MDA,H2O2,Fe2+in tumor tissue increased(P<0.05),while GSH content decreased(P<0.05),the expression of Nrf2,GPX4,FTH1,SLC7A11 protein in tumor tissue decreased(P<0.05),the lncRNA H19 mRNA expression decreased(P<0.05),miR-19b3p mRNA expression increased(P<0.05).Compared with the cisplatin group,the tumor mass of mice in TCM high-dosage combined with cisplatin group reduced(P<0.05),the body mass,spleen index and thymus index increased(P<0.05),the contents of MDA,H2O2,Fe2+in tumor tissue of mice increased(P<0.05),the content of GSH decreased(P<0.05),the expression of Nrf2,FTH1,SLC7A11,GPX4 protein expression decreased(P<0.05),lncRNA H19 mRNA expression decreased(P<0.05),miR-19b3p mRNA expression increased(P<0.05).Conclusion Guiqi Yiyuan Ointment combined with cisplatin can significantly inhibit the tumor of Lewis lung cancer mice,and its mechanism may be related to regulating the expression of ferroptosis molecules related to the lncRNA H19/miR-19b3p/FTH1 axis.