OBJECTIVE:To explore the clinical efficacy and safety of oxymatrine membrane,rhEGF gel respectively com-bined with Yunnan baiyao for postoperative cervical wound after LEEP. METHODS:300 patients with cervical intraepithelial neo-plasia(CIN)Ⅱ and Ⅲ were divided into group A,B,C(100 cases in each group)based on CIN grading and stratification and random sampling in each stratification. After conventional LEEP,patients in group A were cleaned the wound by 0.9% Sodium chloride injection,spraying Yunnan baiyao powder,once only after surgery;patients in group B were additionally given recombi-nant human epidermal growth factor (rhEGF) on the basis of group A,once every week after surgery,for 3 weeks;patients in group C were additionally given oxymatrine membrane on the basis of group A,1 tablet every evening after surgery,for 2 weeks. Postoperative bleeding,bleeding duration,rebleeding and duration after postoperative bleeding stopped,postoperative drainage du-ration,the incidence of adverse reactions in 3 groups were observed. RESULTS:The patients of postoperative bleeding,bleeding time ≥7 d and rebleeding after stopping bleeding in group B were significantly lower than group A;the incidence of bleeding time ≥7 d in group C was significantly lower than group A,the proporition of postoperative drainage duration for less than 7 d was significantly higher than group A,for 8-13 d was significantly less than group A;early wound healing rate in group B and group C were significantly better than group A,with statistical significances (P<0.05). There were no significant differences in above-mentioned indexes in group B and group C(P>0.05),and there were no obvious adverse reactions in 3 groups. CONCLU-SIONS:Oxymatrine membrane and rhEGF gel respectively combined with Yunnan baiyao have better healing than Yunnan baiyao alone,do not increase the incidence of adverse reactions,while there is no significant difference in oxymatrine membrane and rhEGF gel.

Objective:To construct an ultra-early limb movement program for elderly hip fracture surgery patients based on evidence-based practice and the Delphi method.Methods:From May to December 2023, the PIPOST Model (population, intervention, professional, outcome, setting, type of evidence) was used to develop evidence-based questions. Relevant databases were searched to obtain, summarize, and evaluate evidence related to ultra-early limb movement after hip fracture surgery in elderly patients. A draft of the movement program was created with the search timeline set until June 1, 2023. A total of 29 experts were invited to participate in two rounds of Delphi expert consultation to finalize the ultra-early limb movement program for elderly hip fracture surgery patients.Results:A total of 20 studies were included, consisting of six guidelines, four expert consensuses, three systematic reviews, and seven original research articles. The response rates for the two rounds of Delphi expert consultation were 100.00% (29/29) and 86.21% (25/29). The expert authority coefficients were 0.931 and 0.920, and the Kendall coordination coefficients were 0.205 and 0.112 (all P<0.01). The final ultra-early limb movement program for elderly hip fracture surgery patients included four modules and 39 operational items. Conclusions:This study develops an evidence-based, expert-validated ultra-early limb movement program for elderly hip fracture surgery patients, demonstrating its necessity, scientific basis, and practicality. The program provides a reference and guidance for clinical staff in facilitating ultra-early movement for hip fracture patients post-surgery.

Objective:To construct a diabetes foot prediction model for adult patients with type 2 diabetes based on retrospective cohort study using data from a regional health data platform.Methods:Using Yinzhou Health Information Platform of Ningbo, adult patients with newly diagnosed type 2 diabetes from January 1, 2015 to December 31, 2022 were included in this study and divided randomly the train and test sets according to the ratio of 7∶3. LASSO regression model and bidirectional stepwise regression model were used to identify risk factors, and model comparisons were conducted with net reclassification index, integrated discrimination improvement and concordance index. Univariate and multivariate Cox proportional hazard regression models were constructed, and a nomogram plot was drawn. Area under the curve (AUC) was calculated as a discriminant evaluation indicator for model validation test its calibration ability, and calibration curves were drawn to test its calibration ability.Results:No significant difference existed between LASSO regression model and bidirectional stepwise regression model, but the better bidirectional stepwise regression model was selected as the final model. The risk factors included age of onset, gender, hemoglobin A1c, estimated glomerular filtration rate, taking angiotensin receptor blocker and smoking history. AUC values (95% CI) of risk outcome prediction at year 5 and 7 were 0.700 (0.650-0.749) and 0.715(0.668-0.762) for the train set and 0.738 (0.667-0.801) and 0.723 (0.663-0.783) for the test set, respectively. The calibration curves were close to the ideal curve, and the model discrimination and calibration powers were both good. Conclusions:This study established a convenient prediction model for diabetic foot and classified the risk levels. The model has strong interpretability, good discrimination power, and satisfactory calibration and can be used to predict the incidence of diabetes foot in adult patients with type 2 diabetes to provide a basis for self-assessment and clinical prediction of diabetic foot disease risk.

Objective:To develop a prediction model for the risk of diabetic retinopathy (DR) in patients with newly diagnosed type 2 diabetes mellitus (T2DM).Methods:Patients with new diagnosis of T2DM recorded in Yinzhou Regional Health Information Platform between January 1, 2015 and December 31, 2022 were included in the study. The predictor variables were selected by using Lasso-Cox proportional hazards regression model. Cox proportional hazards regression models were used to establish the prediction model for the risk of DR. Bootstrap method (500 resamples) was used for internal validation, and the performance of the model was assessed by C-index, the receiver operating characteristic curve and area under the curve (AUC), and calibration curve.Results:The predictor variables included in the final model were age of T2DM onset, education level, fasting plasma glucose, glycated hemoglobin A1c, urinary albumin, estimated glomerular filtration rate, and history of lipid-lowering agent and angiotensin converting enzyme inhibitor uses. The C-index of the final model was 0.622, and the mean corrected C-index was 0.623 (95% CI: 0.607-0.634). The AUC values for predicting the risk of DR after 3, 5, and 7 years were 0.631, 0.620, and 0.624, respectively, with a high degree of overlap of the calibration curves with the ideal curves. Conclusion:In this study, a simple and practical risk prediction model for DR risk prediction was developed, which could be used as a reference for individualized DR screening and intervention in newly diagnosed T2DM patients.

Objective:To construct a risk prediction model for diabetes kidney disease (DKD).Methods:Patients newly diagnosed with type 2 diabetes mellitus (T2DM) between January 1, 2015, and December 31, 2022, were selected as study subjects from the Yinzhou Regional Health Information Platform in Ningbo City. The Lasso method was used to screen the risk factors, and the DKD risk prediction model was established using Cox proportional hazard regression models. Bootstrap 500 resampling was applied for internal validation.Results:The study included 49 706 subjects, with an median ( Q1, Q3) age of 60.00 (50.00, 68.00) years old, and 55% were male. A total of 4 405 subjects eventually developed DKD. Age at first diagnosis of T2DM, BMI, education level, fasting plasma glucose, glycated hemoglobin A1c, urinary albumin, past medical history (hyperuricemia, rheumatic diseases), triglycerides, and estimated glomerular filtration rate were included in the final model. The final model's C-index was 0.653, with an average of 0.654 after Bootstrap correction. The final model's area under the receiver operating characteristic curve for predicting 4-year, 5-year, and 6-year was 0.657, 0.659, and 0.664, respectively. The calibration curve was closely aligned with the ideal curve. Conclusions:This study constructed a DKD risk prediction model for newly diagnosed T2DM patients based on real-world data that is simple, easy to use, and highly practical. It provides a reliable basis for screening high-risk groups for DKD.

Blocking the biological functions of scaffold proteins and aggregated proteins is a challenging goal. PROTAC proteolysis-targeting chimaera (PROTAC) technology may be the solution, considering its ability to selectively degrade target proteins. Recent progress in the PROTAC strategy include identification of the structure of the first ternary eutectic complex, extra-terminal domain-4-PROTAC-Von-Hippel-Lindau (BRD4-PROTAC-VHL), and PROTAC ARV-110 has entered clinical trials for the treatment of prostate cancer in 2019. These discoveries strongly proved the value of the PROTAC strategy. In this perspective, we summarized recent meaningful research of PROTAC, including the types of degradation proteins, preliminary biological data in vitro and in vivo, and new E3 ubiquitin ligases. Importantly, the molecular design, optimization strategy and clinical application of candidate molecules are highlighted in detail. Future perspectives for development of advanced PROTAC in medical fields have also been discussed systematically.

Background The average sleep quality of mariners during ocean voyages is notably worse than that of the general populace, and the incidence of sleep disorders among them is higher. Sleep disorders closely associate with fatigue and cognitive decline, increasing error and accident rates, and are a major safety hazard in marine navigation. At present, research on factors influencing the sleep quality of mariners during ocean voyages in China is limited and needs further investigation. Objective To investigate the sleep quality of mariners during ocean voyages and analyze its influencing factors, in order to provide reference for constructing sleep intervention plans and mitigating their sleep disorders. Methods Using convenience cluster sampling, a questionnaire survey was carried out in 408 crew members of a fleet who returned from a voyage on March 21, 2024. The questionnaires included a general information questionnaire, Pittsburgh Sleep Quality Index (PSQI) , and Self Rating Anxiety Scale (SAS), and the data were analyzed by SPSS 26.0 software. Results A total of 399 valid questionnaires were collected, with an effective recovery rate of 97.8%. The mean score of PSQI for the mariners during ocean voyages was (6.41±2.44), with 33.6% (134/399) of the mariners reporting sleep disorders. The PSQI scores varied by family structures (t=2.235, P=0.031), labor types (F=3.789, P=0.023), noise exposure (F=53.218, P＜0.001), dietary patterns (F=63.311, P＜0.001), exercise habits (F=16.416, P＜0.001), and anxiety states (t=5.963,P＜0.001). The results of linear regression showed that incomplete family structure (β=0.102, P=0.010), noise exposure (β=0.323, P<0.001), and anxiety (β=0.117, P=0.006) positively associated with the total score of PSQI, while dietary patterns (β=-0.331, P<0.001) and exercise habits (β=-0.147, P<0.001) negatively associated with the total PSQI score, and the 5 variables jointly explained 38.9% of the total variation in the PSQI score (F=37.159, P<0.01). Conclusion The sleep quality of mariners during ocean voyages is relatively low and the incidence of sleep disorders is relatively high, which is jointly influenced by factors such as family structure, noise exposure, dietary habits, exercise habits, and anxiety.

BACKGROUND: Current guidelines recommend hepatocellular carcinoma (HCC) screening in high-risk populations. However, the ideal HCC screening interval and screening modality have not been determined. This study aimed to compare the screening efficacy among different modalities with various intervals. METHODS: PubMed and other nine databases were searched through June 30, 2021. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Survival rates were also pooled using RR with 95% CIs because most eligible studies only provided the number of survival patients instead of hazard ratio. RESULTS: In all, 13 studies were included. Two random controlled trials (RCTs) and six cohort studies compared screening intervals for ultrasonography (US) screening and found no significant differences between shorter (3- or 4-month) and longer (6- or 12-month) screening intervals in terms of early HCC proportion, HCC significant mortality, 1-year survival rate; screening at 6-month interval significantly increased the proportion of early HCC (RR = 1.17, 95% confidence interval [CI]: 1.08-1.26) and prolonged the 5-year survival rate (RR = 1.39, 95% CI: 1.07-1.82) relative to the 12-month interval results. Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B, which indicated no statistical differences in the proportion of early HCC (RR = 0.89, 95% CI: 0.40-1.96) and HCC mortality (RR = 0.69, 95% CI: 0.23-2.09) between the biannual US and annual computed tomography (CT screening). Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging (MRI) (RR = 0.60, 95% CI: 0.37-0.97) and biannual US combined with annual CT (RR = 1.31, 95% CI: 1.13-1.51) screening. The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US (RR = 1.08, 95% CI: 1.00-1.23) group. CONCLUSIONS: The evidence suggests that 6 months may be the best HCC screening interval for US screening. The effectiveness of CT and MRI is better than US during same screening intervals. However, MRI and CT are more expensive than US, and CT also can increase the risk of radiation exposure. The selection of CT or MRI instead of US should be carefully considered. REGISTRATION No. CRD42020148258 at PROSPERO website ( https://www.crd.york.ac.uk/PROSPERO/ ).
Humans ; Carcinoma, Hepatocellular/pathology* ; Liver Neoplasms/pathology* ; Liver Cirrhosis/complications* ; Risk Factors ; Cohort Studies

Shengmai formula,composed of Ginseng Radix et Rhizoma,Ophiopogon Radix and Schisandrae Chinensis Fructus,is a classic and famous formula.It is a representative formula for"supplementing qi,nourishing yin,and generating fluid"in Traditional Chinese Medicine theory.To date,a wide range of Shengmai formulae have been developed according to different medical applications,but the quality evaluation standards are at a relatively low level,and most of them only specify the individual components of a single herb,making it difficult to ensure clinical efficacy and safety.At the same time,the physical and chemical identification methods of Shengmai formula have been constantly updated,allowing for greater progress in research on its main chemical components such as saponins,lignans and flavonoids.However,there is little systematic summarization of the chemical components and analytical methods.Based on the existing references,we systematically summarized ginsenosides,ophiopogonins,schisandra lignans,homoisoflavonoids and some other compounds in this paper,as well as the quality standards of Shengmai formulae and their analytical methods in order to aid clinical research and formulation manufacture.

Objective: To investigate and summarize the effect of narrative nursing on anxiety and depression in patients undergoing coronary artery bypass grafting, and to provide reference for the formulation of clinical nursing plan. Methods: A total of 61 patients underwent coronary artery bypass grafting were selected. 31 cases of narrative nursing were taken as the research group, and routine nursing was used in the other 30 cases as control group. Depression and anxiety were assessed by Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) before, 7 days after and 14 days after surgery. Results: Totally 61 patients were successfully operated and no case died during hospitalization. There was no significant difference in SAS and SDS scores between the 2 groups before surgery. The SAS scores in the study group were 57.9±4.2, 50.8±4.9, 47.1±5.0 on the day of admission,7 days after operation and 14 days after operation, respectively, while those in the control group were 58.4±3.7, 57.9±5.2, 55.7±6.2. There were significant differences between the two groups after intervention (t=5.490, 5.973, P<0.01). The SAS score of the study group decreased 7 days after operation and 14 days after operation compared with that of the admission day (t= 6.125, 9.209, P < 0.01). The SDS scores in the study group were 54.3±4.6, 49.4±4.7, 42.7±4.8 on the day of admission,7days after operation and 14 days after operation, respectively, while those in the control group were 54.1±5.1, 52.3±5.6, 51.6±5.2. There were significant differences between the two groups after intervention (t=2.194, 6.949, P<0.01). SDS scores in the study group decreased 7 days after operation and 14 days after operation compared with the day of admission in this group, with significant differences (t=4.148, 9.715, P < 0.01). Conclusions Narrative nursing is helpful to relieve anxiety and depression in patients undergoing coronary artery bypass grafting.