OBJECTIVE To clarify the weight index and optimize the technology of compound Mingmu Yijing pills. METHODS Water content, dissolution time limit and bolus-forming pass rate were included as evaluation indexes. The analytic hierarchy process(AHP) and the criterion importance through inter-criteria correlation(CRITIC) method based on the objectivity of indicators were adopted, AHP-CRITIC mixed weighting method. In this way, the relative coefficients of each index were calculated for weight distribution and comprehensive score, and the molding process was optimized and verified by Box-Behnken response surface test. RESULTS Compared with the single weighting method, the AHP-CRITIC mixed weighting method was more reasonable and stable. This method finally optimized the forming process conditions of Mingmu Yijing pills as follows: adding water amount of 0.8 times, the damp mass infiltration for 0.5 h, drying temperature of 60 ℃, drying time of 8 h. The mean comprehensive score of validation experiment was 88.21, RSD was 0.29%. CONCLUSION AHP-CRITIC method scientifically determines the weight of multiple indicators, and the verification test confirms that the optimized molding process is stable and feasible, which can be used in practical large-scale production.

Objective:To investigate the factors influencing the success of external cephalic version.Methods:Pregnant women who underwent an external cephalic version due to breech or transverse presentation by the same operator in the Third Affiliated Hospital of Zhengzhou University from July 2015 to July 2021 were selected as the study objects. Univariate analysis and logistic regression analysis were used to explore the clinical factors influencing the success of the external cephalic version. The receiver operating characteristic (ROC) curve was used to analyze the best cut-off value of gestational week and amniotic fluid index at the time of operation and to evaluate the predictive value of the influencing factors on the success of the external cephalic version.Results:(1) A total of 118 cases finally entered this study. Among the 118 cases,77 cases (65.3%) succeeded in the external cephalic version, among which the success rate was 49.1% (27/55) for primipara and 79.4% (50/63) for multipara. The vaginal delivery rate was 56.8% (67/118). (2) Complications occurred in 19 (16.1%) of the 118 cases. The main complications were abnormal fetal heart rate (13 cases, 11.0%), umbilical cord presentation, and fetal position reversion (two cases and 1.7% in each), and the serious complications were intrauterine fetal death and placental abruption (one case and 0.8% in each).The complication rate of patients with successful external cephalic version was 7.8% (6/77), which was lower than that of those who failed the external cephalic version [31.7%(13/41)] ( χ 2=11.33, P=0.001). (3) Multivariate analysis showed that gestational week at surgery before 38, amniotic fluid index >11.10 cm, and multipara were the factors affecting the success of the external cephalic version [ OR(95% CI)=0.561(0.351-0.897), 1.173(1.018-1.351) and 4.201(1.547-11.404), all P<0.05]. (4) The area under the ROC curve of the combination of the gestational week at surgery, amniotic fluid index, and parity was 0.744 (95% CI: 0.640-0.848, P<0.001), and the Youden index was 0.518, with a sensitivity of 70.0% and a specificity of 81.8%. Conclusion:Gestational weeks, amniotic fluid index, and multipara are related to the success of the external cephalic version, and the combination of the three has certain predictive power for the success of the surgery.

Objective:To investigate the clinicopathological, molecular pathological features, and family genetic pedigree of small cell carcinoma of the ovary, hypercalcemic type (SCCOHT).Methods:A total of 16 cases of SCCOHT diagnosed in Obstetrics and Gynecology Hospital of Fudan University from January 2013 to January 2023 were collected. The clinicopathologic features, SMARCA4/2/B1 protein expression, outcomes and SMARCA4 gene detection were reported. A follow-up study was also carried out.Results:The average age at diagnosis was 28.7 years (range 17-38 years). The preoperative calcium level was evaluated in 3 of 6 patients. The tumor was unilateral in all 16 cases, ranged from 8 to 26 cm (average 15.8 cm) in the greatest dimension. Extraovarian spread was present in 7 cases. In 10 cases, the tumors were initially misinterpreted as other ovarian neoplasms. BRG1 and BRM expression by immunohistochemistry were all lost in detected cases, while INI1 exhibited retained nuclear expression. All BRM-negative SCCOHTs also lacked BRG1 protein,but retained INI1 expression. SCCOHTs were only focally positive for EMA, CKpan, Calretinin, SALL4, and diffusely positive for WT1. Two of nine cases exhibited mutation-type p53 immunoreactivity. Ki-67 index was 58% on an average. ER, PR, FOXL2, α-inhibin, chromogranin A and LCA were negative in all the cases. SMARCA4 sequencing was available in 8 cases of SCCOHT, which revealed a germline SMARCA4 mutation in one patient, and others carried somatic mutation. Furthermore, two daughters, mother and an aunt of a patient with germline mutation were reported to be SMARCA4 mutation carriers. Follow-up was available for 15 patients, and the 6-month, 1-year and 2-year survival rate was 65.8%, 45.1%, and 22.6%, respectively. For patients in FIGO stages Ⅱ+Ⅲ, 6-month, 1-year survival rate was 53.6% and 35.7% respectively, compared to 80% (6-month) and 60% (1-year) in patients of staged I ( P=0.358). Conclusions:With dismal prognosis of SCCOHT, accurate diagnosis is necessary. The typical age distribution, a panel of various staining results, especially concomitant loss of BRG1 and BRM may be of diagnostic aid and can be used to distinguish SCCOHT from its histological mimics. After the diagnosis of SCCOHT, genetic testing and genetic counseling are recommended.

Objective:To evaluate the efficacy of endoscopic stenting drainage for patients with malignant hilar biliary obstruction caused by unresectable hepatocellular carcinoma.Methods:Data of 106 patients with malignant hilar obstruction caused by unresectable hepatocellular carcinoma who received endoscopic stenting drainage in the Third Affiliated Hospital of Naval Medical University from January 2012 to January 2019 were retrospectively analyzed. According to the different stent types, they were divided into the metal stent group (30 cases) and the plastic stent group (76 cases). The observation indexes included clinical success rate, complication incidence, stent patency and overall survival time. The independent predictors for stent patency and overall survival of patients were analyzed by multivariate Cox regression model.Results:The overall clinical success rate was 67.9% (72/106) and the incidence of postoperative cholangitis was 29.2% (31/106). The clinical success rates were 93.3% (28/30) and 57.9% (44/76) ( χ2=12.40, P<0.001), and the incidences of postoperative cholangitis were 13.3% (4/30) and 35.5% (27/76) ( χ2=5.12, P=0.024) in the metal stent group and the plastic stent group, respectively. The median stent patency was 5.2 (95% CI:3.7-6.0) months, and the overall survival time was 3.0 (95% CI:2.5-3.7) months. Multivariate Cox regression analysis showed that hepatic drainage volume <30% was an independent predictor for stent patency ( HR=2.12, 95% CI:1.01-4.46, P=0.048). Bismuth type Ⅳ ( HR=2.06, 95% CI:1.12-3.77, P=0.020), Child-Pugh class C ( HR=4.09, 95% CI: 2.00-8.39, P<0.001) and plastic stent ( HR=1.87, 95% CI:1.21-2.90, P=0.005) were independent predictors for overall survival time. Conclusion:Hepatocellular carcinoma involving the hilar bile duct has a poor prognosis. Compared with plastic stents, metal stents show advantages in clinical success rate and incidence of postoperative cholangitis. Hepatic drainage volume <30% is an independent predictor for stent patency, and Bismuth type Ⅳ, Child-Pugh class C and plastic stent are independent predictors for overall survival time.

OBJECTIVE: To diagnose a 46,XN,del(11)(q14q22) fetus by non-invasive prenatal testing (NIPT), karyotype analysis and whole genome sequencing (WGS). METHODS: Peripheral blood sample of the gravida was taken for NIPT screening. Blood samples of the gravida, her husband, and umbilical cord blood were also taken for chromosome karyotyping and whole genome sequencing (WGS). RESULTS: NIPT screening indicated the fetus has carried partial deletion of chromosome 11, while no chromosomal abnormality was found with the cord blood sample due to the low resolution of G-banding analysis. WGS analysis of the cord blood indicated 46,XN,del(11q14.3q22.1). seq[GRCh37/hg19] (90 623 404-97 469 319)×1, 6.85 Mb. The karyotype of the fetus was eventually determined as 46,XN,del(11)(q14q22). Karyotyping analysis suggested that the gravida and her husband were 46,XX,del(11)(q14q22)[8]/46,XX[92] and 46,XY, respectively. However, neither of them was found to harbor the del(11)(q14q22) by WGS. CONCLUSION The abnormal karyotype of the fetus has derived from its mother's low percentage mosaicism. Combined NIPT, karyotyping analysis and WGS can detect chromosomal disorders with accuracy.

Objective:To explore the effects of health education based on transtheoretical model on behavior and psychological status of family members of children with Henoch-Schonlei purpuric nephritis (HSPN) .Methods:From March 2016 to January 2018, we selected 82 HSPN children family members of Department of Pediatrics in Mianyang Central Hospital. All children family members were divided into control group and observation group with the random envelope method, 41 cases in each group. Family members of control group received routine health education, while family members of observation group were treated with health education based on transtheoretical model. Psychological condition, coping style, knowledge belief and practice of family members were evaluated with the Connor-Davidson Resilience Scale (CD-RISC) , the Coping Health Inventory for Parents (CHIP) and the self-designed Knowledge Belief and Practice Questionnaire before and after intervention. We also counted the recurrence rate of HSPN among children between two groups 6 months after discharge.Results:On the day of admission, there were statistical differences in the dimension scores and the total scores of CD-RISC, CHIP and the Knowledge Belief and Practice Questionnaire of family members of children between two groups ( P>0.05) . On the day of discharge, the dimension scores and the total scores of CD-RISC, CHIP and the Knowledge Belief and Practice Questionnaire of family members of children in observation group were higher than those in control group with statistical differences ( P<0.05) . The cumulative recurrence rate of HSPN among children in observation group was lower than that in control group after 6 months of follow-up, but the difference was not statistically significent ( P>0.05) . Conclusions:Health education based on transtheoretical model can improve the psychological status of family members of children with HSPN and mental resilience, promote the change of their coping styles, raise the improvement effect of knowledge belief and practice, and help reduce the recurrence rate of children.

OBJECTIVE： To study the effects of cimetidine on low dose rate irradiation-induced liver cell apoptosis in Beagle dogs. METHODS： Healthy male Beagle dogs were randomly divided into normal control group， model control group， positive drug group （lentinan， 21.33 mg/kg） and cimetidine low-dose， medium-dose and high-dose groups （5.33， 10.67， 21.33 mg/kg）， with 4 Beagle dogs each. Except for normal control group， other groups were given 60Co-γ accumulative irradiation （dosage rate： 0.040 8 mGy/min） for 23 d； the medication groups were given relevant medicine orally before irradiation， once a day. Twenty-four hours after stopping irradiation， TUNEL method was used to detect the apoptosis of liver cells in Beagle dogs. The percentage of apoptotic cells was calculated. The expression level of apoptosis-related proteins （Bax， Bcl-2， Caspase-3， p53） in liver tissue was detected by immunohistochemistry. RESULTS： Compared with normal control group， apoptotic cells and Bax， Caspase-3， p53 positive cells were increased significantly in liver tissue of Beagle dogs in model control group； the percentage of apoptotic cells， protein expression levels of Bax， Caspase-3 and p53 were increased significantly； Bcl-2 positive cells were decreased significantly， and its protein expression level was decreased significantly （P＜0.05 or P＜0.01）. Compared with model control group， above positive cells of liver tissue in Beagle dogs were changed to different extents in medication groups； the percentage of apoptotic cells and protein expression levels of p53 in medication groups， protein expression levels of Bax in positive drug group， cimetidine low-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were decreased significantly； protein expression levels of Bcl-2 were increased significantly in cimetidine groups. The percentage of apoptotic cells in cimetidine medium-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were all lower than positive control group. Protein expression level of p53 in cimetidine low-dose group was significantly higher than positive drug group （P＜0.05 or P＜0.01）. CONCLUSIONS： Cimetidine can inhibit the low dose rate irradiation-induced apoptosis of liver cells in Beagle dogs， and certainly protect liver cells against irradiation. The mechanism of it may be associated with up-regulating the protein expression of Bcl-2 and down-regulating the protein expression of Bax， Caspase-3 and p53 in liver cells.

OBJECTIVE:To establish a method for simultaneous determination of gallic acid,magnoflorine,ellagic acid,jatrorrhizine hydrochloride,palmatine hydrochloride,berberine hydrochloride and curcumin in Siwei jianghuang decoction powder.METHODS:HPLC method was adopted.The determination was performed on Capcell Pak C18-MG Ⅱ column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid (gradient elution) at the flow rate of 0.8 mL/min.The detection wavelengths were 270 nm (0-60 min,gallic acid,magnoflorine,ellagic acid,jatrorrhizine hydrochloride,palmatine hydrochloride,berberine hydrochloride) and 428 nm (60-70 min,curcumin).The column temperature was set at 30 ℃,and sample size was 10 μL.RESULTS:The linear ranges of gallic acid,magnoflorine,ellagic acid,jatrorrhizine hydrochloride,palmatine hydrochloride,berberine hydrochloride and curcumin were 0.249 6-1.497 6,0.284 0-1.704 0,0.075 6-0.453 6,0.015 9-0.095 9,0.023 6-0.141 6,0.098 2-0.589 0 and 0.060 4-0.362 4 μtg (r≥0.999 8).The limits of detection were 6.24,4.73,7.56,2.36,3.20,6.54,6.04 ng,and the limits of quantitation were 17.47,16.08,20.86,7.31,10.24,19.62,19.32 ng,respectively.RSDs of precision,stability (12 h),reproducibility tests were lower than 2.0％ (n=6).The recoveries were 95.45％-103.47％ (RSD=0.86％-1.98％,n=9).CONCLUSIONS:Established method is simple,accurate,reliable and suitable for simultaneous determination of 7 components such as gallic acid in Siwei jianghuang decoction powder.

OBJECTIVE:To optimize extraction technology of cortex of Berberis dictyophylla by ethanol. METHODS:Using the contents of magnoflorine,jatrorrhizine hydrochloride,palmatine hydrochloride and berberine hydrochloride,the amount of extract as evaluation indexes,the effects of ethanol amount,volume fraction of ethanol and extraction time on extraction technology were investigated by uniform design method-comprehensive scoring method. The extraction methods of first time, second time and third time were investigated by 3 times of uniform design test. The optimal schemes of 3 times of extraction test were determined and validation test was conducted,and the transfer rates were calculated. RESULTS:The optimal technology was as follows as coarse powder of cortex of B. dictyophylla,15-fold 75% ethanol,extracting for 2 times,120 min each time. In validation test,the contents of magnoflorine,jatrorrhizine hydrochloride,palmatine hydrochloride and berberine hydrochloride were 58.96,4.82,3.07,23.29 mg/g after B. dictyophylla was extracted by optimization technology for 2 times. The transfer rates were 93.85%,95.02%,96.28%,94.88%,respectively(RSD=3.87%,2.64%,4.00%,3.91%,n=3). CONCLUSIONS:The optimal ethanol reflux extraction technology of cortex of B.dictyophylla is reasonable and feasible with good stability.

OBJECTIVE:To optimize the extraction technology of Duoxuekang. METHODS:Using comprehensive score of salidroside,gallic acid content and extraction yield as indexes,U6(63)uniform design was designed to optimize the liquid-solid ra-tio,ethanol volume fraction and extraction time of Duoxuekang,then optimize extraction times,and verification test was conduct-ed. RESULTS:The optimal extraction technology was as follows as 50% ethanol,liquid-solid ratio of 1:14,soaking time of 1.5 h,reflux extraction for 1 h and repeated twice;the average extraction yield in 3 tests was 50.18%,contents of salidroside and gal-lic acid were 1.82 mg/g,16.54 mg/g (RSD≤0.84%,n=3). CONCLUSIONS:The optimized extraction technology for Duox-uekang is reasonable,simple and feasible.