ObjectiveTo evaluate the clinical efficacy and safety of Jingmaiyan granules （composed of Lonicerae Japonicae Flos， Sedi Herba， Paeoniae Radix Rubra， Moutan Cortex， Rhei Radix et Rhizoma Praeparata， and Glycyrrhizae Radix et Rhizoma） combined with external application of Jinhuang Ointment in treating acute-stage blood heat stasis type superficial thrombophlebitis （ST） of lower extremities， and to explore their effects on hemorheology and serum inflammatory factors. MethodsA randomized， double-blind， placebo-controlled clinical trial was conducted. A total of 124 patients with lower extremity ST were randomized into two groups（62 cases in each group）. The control group received external application of Jinhuang ointment and oral placebo treatment， while the observation group received external application of Jinhuang ointment and oral Jingmaiyan granules. Both groups were treated for 2 weeks. The clinical symptom scores， therapeutic efficacy of traditional Chinese medicine （TCM） syndrome， pain visual analog scale （VAS） scores， hemorheological indices ［including whole blood high-shear， medium-shear， and low-shear viscosity， as well as plasma viscosity （PV）］， and inflammatory factors ［C-reactive protein （CRP）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）］ were compared before and after treatment. ResultsAfter 2 weeks of treatment， the total effective rate in the observation group （98.3%， 60/62） was significantly higher than that in the control group （83.8%， 52/62）， with a statistically significant difference （Z=3.512 1， P<0.05）. Compared with pre-treatment scores， the scores for skin color， skin temperature， swelling， pain， and cord or nodules were significantly reduced in both groups （P<0.05）， with more pronounced improvement in the observation group （P<0.05）. Additionally， compared with pre-treatment levels， the whole blood viscosity （low-， medium-， and high-shear） significantly improved in both groups after treatment （P<0.05）， with more marked improvement in the observation group （P<0.05）. Furthermore， the plasma viscosity， CRP， IL-6， and TNF-α levels were significantly reduced in both groups after treatment （P<0.05）， with more pronounced improvement observed in the observation group （P<0.05）. ConclusionThe combination of external application of Jinhuang ointment and oral Jingmaiyan granules effectively improves clinical symptoms， hemorheological abnormalities， and inflammatory responses in patients with acute stage blood heat stasis type ST of lower extremities. The treatment is safe and holds clinical promotion value.

Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

ObjectiveTo improve the accuracy of discrete element method in simulating the processing of traditional Chinese medicine（TCM） powder system under low shear conditions. MethodsIn this study， extract powders of Tongsaimai tablets and Qige granules were used as the research objects， the angle of repose（AOR） and effective angle of internal friction of the two materials were determined by AOR test method and shear cell test method. Based on the Hertz-Mindlin with JKR V2 contact model and particle scaling theory， taking the particle-particle restitution coefficient（A）， particle-particle static friction coefficient（B）， particle-particle rolling friction coefficient（C）， particle-steel restitution coefficient（D）， particle-steel static friction coefficient（E）， particle-steel rolling friction coefficient（F） and Johnson-Kendall-Roberts（JKR） surface energy（G） as test factors， the simulated contact parameters of Tongsaimai tablets extract powder were first calibrated with a single reference value using AOR as the reference value， and then the simulated contact parameters of Tongsaimai tablets extract powder as well as Qige granules extract powder were co-calibrated with AOR and effective angle of internal friction as the joint reference value， respectively. Then， Plackett-Burman design was used to screen the critical contact parameters that have a significant effect on the simulated reference value， and the steepest ascent design was used to determine the optimal range of the critical contact parameters， finally， the regression model between the critical contact parameters and the simulated reference values was established through the design of the response surface test， and the critical contact parameters were calibrated based on the regression model and the desirability function approach. ResultsThe optimal combination of discrete elemental contact parameters A-G for Tongsaimai tablets extract powder under a single reference value was 0.100， 0.718， 0.616， 0.100， 0.400， 0.250 and 0.075 J·m^-2， which was validated to have relative errors of 0.10% and -8.64% for the simulated AOR and the simulated effective angle of internal friction， respectively. And the optimal combination of discrete elemental contact parameters A-G for Tongsaimai tablets extract powder at the joint reference values was 0.100， 0.682， 0.598， 0.100， 0.521， 0.294 and 0.075 J·m^-2， which was verified to have relative errors of 0.10% and -0.18% for the simulated AOR and the simulated effective angle of internal friction， respectively. The optimal combination of discrete elemental contact parameters A-G for Qige granules extract powder at the joint reference values was 0.150， 0.370， 0.330， 0.150， 0.500， 0.500 and 0.100 J·m^-2， which was verified to have relative errors of 2.70% and -1.30% for the simulated AOR and the simulated effective angle of internal friction， respectively. Compared with the single reference value method， the joint calibration method not only increased the number of the critical contact parameters for characterizing particle-device interactions， but also was more accurate and reliable. ConclusionCompared with the results of single reference value calibration， the results obtained by the method of joint calibration of discrete element simulation contact parameters with AOR and effective angle of internal friction as the reference values are more accurate， which can provide more accurate and reliable simulation physical property data for the simulation experiments of TCM extract powder under low shear process conditions.

Objective:To analyze and clarify the meaning of the concept of self-advocacy among patients with chronic diseases using the Rodgers evolutionary concept analysis method.Methods:A systematic search was conducted in databases including PubMed, Web of Science, Cochrane Library, CINAHL, Embase, Medline, VIP, Wanfang, the China National Knowledge Infrastructure, and Chinese Biomedical Literature Database for studies related to self-advocacy in chronic disease patients from February 1, 1992, to June 30, 2024. The Rodgers evolutionary concept analysis method was applied to analyze the selected literature.Results:A total of 72 articles were included in this study. The concept attributes of self-advocacy in chronic disease patients were identified as cognitive awareness, self-action, and resource integration. The antecedents involved included personal characteristics, skill learning, and available support. The outcomes covered improved symptom management, adherence to treatment plans, enhanced nursing and quality of life, and reduced demand for healthcare. The measurement tools used were the Patient Self-Advocacy Scale, Self-Advocacy Scale, Elderly Safety Advocacy Empowerment Scale, and Female Cancer Patient Self-Advocacy Scale.Conclusions:The conceptual attributes of self-advocacy in chronic disease patients were clarified through the Rodgers evolutionary concept analysis method. Future research can combine quantitative and qualitative studies to further explore the significance of self-advocacy in patients with chronic diseases.

OBJECTIVE T o explore the long-term effect of multidimensional evidence-based interventions based on i-PARIHS theoretical framework on reduction of incidence of central line-associated bloodstream infections(CLABSI)in pediatric intensive care units(PICU)of pediatrics department and evaluate the impact on nurses'compliance to taking the interventions and use intensity of catheters.METHODS By means of quasi-experimental design,the multidimensional intervention system covering multidisciplinary collaboration,standardized operation procedures,information system optimization and hierarchical training was established and staged for implementa-tion of 5 years(from T0 baseline stage to T3 maintenance stage).The variations in implementation rates of cathe-ter maintenance(daily maintenance,dressings change,catheter removal)were analyzed by Chi-square test,and the change of incidence of CLABSI was monitored with the use of statistical process control U chart.RESULTS The nurses'compliance to operations was remarkably improved(P＜0.05)o The implementation rate of dressings change continuously increased from 52.91％in T0 to81.62％in T3(x2=72.444,P＜0.001),the implementa-tion rate of catheter removal increased from 48.72％to 79.31％(x2=8.179,P=0.042).The incidence rate of CLABSI decreased from 1.92％0 in 2019 to 0.5％0 in 2022,and the control chart showed that most of the months fluctuated within control limits.CONCLUSIONS The multidimensional evidence-based interventions can achieve a long term control of CLABSI by raising the nurses' compliance to operations.The information monitoring and closed-loop management are crucial to maintenance of the interventional effect,and the risk early warning system should be optimized with the combination of artificial intelligence technology.

BACKGROUND: Several randomized controlled studies have suggested that the prophylactic use of proton pump inhibitors (PPIs) in intensive care unit (ICU) patients could not reduce the incidence of gastrointestinal bleeding (GIB) and may increase adverse events such as intestinal infection and pneumonia. Gut microbiota may play a critical role in the process. PPIs have been widely prescribed for GIB prophylaxis in patients with acute coronary syndrome (ACS). This study aimed to determine the short-term effects of PPI and histamine-2 receptor antagonist (H2RA) treatment on gut microbiota of ACS patients. METHODS: The study was designed as a single-blind, multicenter, three-parallel-arm, randomized controlled trial conducted at three centers in Beijing, China. We enrolled ACS patients at low-to-medium risk of GIB and randomized (2:2:1) them to either PPI ( n = 40), H2RA ( n = 31), or control group ( n = 21). The primary outcomes were the alterations in gut microbiota after 7 days of acid suppressant therapy. Stool samples were collected at baseline and 7 days and analyzed by 16S ribosomal RNA (rRNA) gene sequencing. RESULTS: There were no significant changes in the diversity of gut microbiota after the short-term use of acid suppressants, but the abundance of Fusobacterium significantly increased and that of Bifidobacterium significantly decreased, especially in PPI users. In addition, the abundance of some pathogenic bacteria, including Enterococcus and Desulfovibrio, was significantly elevated in the PPI users. The fecal microbiota of the PPI users included more arachidonic acid metabolism than that of control group. CONCLUSIONS: PPIs may increase the risk of infection by adversely altering gut microbiota and elevating arachidonic acid metabolism, which may produce multiple proinflammatory mediators. For ACS patients at low-to-medium risk of GIB, sufficient caution should be paid when acid-suppressant drugs are prescribed, especially PPIs. REGISTRATION www.chictr.org.cn (ChiCTR2000029552).
Humans ; Proton Pump Inhibitors/therapeutic use* ; Acute Coronary Syndrome/microbiology* ; Female ; Gastrointestinal Microbiome/drug effects* ; Male ; Middle Aged ; Histamine H2 Antagonists/therapeutic use* ; Aged ; Single-Blind Method

Objective To investigate the effect of surgical intervention on IVF/ICSI assisted conception outcomes in patients with ovarian endometriosis(OEM).Methods OEM patients who underwent IVF/ICSI treat-ment at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University between January 1,2019 and February 1,2024 were selected,including 228 cases in the non-operated group before assisted conception(Group A)and 426 cases in the operated group before assisted conception(Group B),and the assisted concep-tion outcomes of the two groups were analysed.Results There were no statistically significant differences in female age,BMI,infertility years,infertility type,and basal FSH level between the two groups(P＞0.05).AMH level and basal AFC were higher in group A than in group B(P=0.003).There was no statistical difference in the application of ovulation induction programme,total number of Gn days and total amount of Gn between the two groups(P＞0.05),but the amount of Gn initiation in Group A was lower than that in Group B(P=0.011).Applying multiple linear regression to adjust for confounding factors,there was a statistical difference in the 2PN fertilization rate between Groups A and B(P=0.007),whereas there was no statistical difference in the number of eggs obtained,the rate of available embryos,the rate of high-quality embryos and the rate of blastocyst formation between the two groups(P＞0.05).After applying binary logistic regression to adjust for the influencing factors related to clinical pregnancy rate and live birth rate,the clinical pregnancy rate(aOR=-0.896,95％CI:0.540～1.488),live birth rate in the two groups(aOR=0.976,95％CI:0.589～1.620)remained statistically indistin-guishable.Conclusions Surgical intervention may further impair ovarian reserve function in patients with OEM,but does not appear to affect embryo quality or pregnancy outcome.Surgical treatment prior to assisted conception may improve fertilization rates in patients with OEM.

Objective:To understand the coverage and information consistency rate of National Immunization Program (NIP) vaccines among children born during 2020-2021 in Zhejiang Province, Chongqing City, and Shanxi Province (3 provinces) of China .Methods:A simple random sampling method was used to randomly select 3 counties (districts) from each of the 3 provinces, 5 townships from each county (district), and 5 villages from each township. Vaccination information for seven NIP vaccines was collected for children born between 2020 and 2021 in each village. The vaccination coverage, timely coverage, and consistency rates between the survey data and the Immunization Planning Information System data were analyzed.Results:A total of 1 117 children were investigated. The vaccination coverage for each dose of NIP vaccine ranged from 99.10% to 100.00%, with those in Zhejiang Province, Chongqing City, and Shanxi Province ranging from 99.19% to 100.00%, 98.92% to 100.00%, and 99.20% to 100.00%, respectively. The timely coverage of each dose of NIP vaccine ranged from 89.79% to 99.82%, with those in Zhejiang Province, Chongqing City, and Shanxi Province ranging from 94.09% to 99.73%, 89.52% to 99.73%, and 78.55% to 100.00%, respectively. The consistency rate of information on each dose of NIP vaccine ranged from 94.36% to 99.91%, with those in Zhejiang Province, Chongqing City, and Shanxi Province ranging from 97.85% to 99.73%, 98.92% to 100.00%, and 86.06% to 100.00%, respectively.Conclusions:Coverage of NIP vaccines was generally high among children born during 2020-2021 in the 3 provinces of China, but there were regional differences in the timely coverage of some vaccine doses and the vaccination information consistency rate. It is necessary to strengthen the timely vaccination of children's vaccine booster doses and optimize the management of vaccination services.

OBJECTIVE To explore the epidemiological characteristics of tuberculosis complicated with human im-munodeficiency virus(HIV)infection and their relationships with T helper lymphocyte(Th)1/Th2 related fac-tors.METHODS From May 2022 to Feb.2024,118 patients with tuberculosis combined with HIV infection admit-ted to Guiyang Public Health Rescue Center were selected as the study group.The patients were divided into group A(＞1.0E3 cp/ml＜1.0E4 cp/ml)with 31 cases,group B(≥1.0E4 cp/ml＜1.0E5 cp/ml)with 36 cases,group C(≥1.0E5 cp/ml)with 51 cases according to viral load.Another 120 patients with simple pulmonary tu-berculosis were selected as control group.The characteristics of epidemic cases,imaging CT features and levels of Th1/Th2 related cytokines[including interleukin-2(IL-2),tumor necrosis factor-α(TNF-α),interferon γ(IFN-γ),IL-4,IL-6 and IL-10]were compared between the study group and the control group,and the relationship be-tween viral load and atypical CT manifestations of tuberculosis were analyzed.RESULTS There were significant differences in educational level,occupational status,intravenous drug use history and baseline CD4 values between the two groups(P＜0.05).The study group showed higher rates of CT manifestations such as multiple pulmona-ry fields and segments exudation,extrapulmonary tuberculosis,multiple cavities,intrathoracic lymph node en-largement,multiple nodules,and diffuse miliary shadow than the control group,conversely,the frequencies of single cavity,calcification and speckle shadow in the study group were lower than those in the control group(P＜0.05).Compared with the control group,the levels of IL-2,TNF-α and IFN-γ in the study group were low,while the levels of IL-4,IL-6 and IL-10 were high(P＜0.05).With the increase of viral load,the rates of atypical CT tuberculosis were also increased(P＜0.05).CONCLUSION The CT imaging findings in patients with tuberculosis combined with HIV infection are atypical and Th1/Th2 related cytokines are abnormal,and the chest CT manifes-tations are associated with high viral load.

Objective To investigate the correlation between serum levels of macrophage inflammatory protein-1α(MIP-1α),apolipoprotein C1(APOC1),cysteine leukotrienes(CysLTs)and prognosis in children with severe Mycoplasma pneumoniae pneumonia.Methods The children with severe M.pneumoniae pneumonia admitted to the Second Hospital of Handan City from January 2022 to December 2023 were included as case group.The children in case group were assigned to a good prognosis group(n=69)or poor prognosis group(n=24)according to patient outcome.Additionally,93 healthy children who underwent physical examination were included as control group.Enzyme linked immunosorbent assay(ELISA)was applied to determine the serum levels of MIP-1α,APOC1,and CysLTs.Pearson correlation was used to analyze the correlation between serum levels of MIP-1α,APOC1,CysLTs and other biomarkers.Receiver operating characteristic(ROC)curve was plotted to analyze the value of MIP-1α,APOC1,and CysLTs levels for predicting the outcome of children with severe M.pneumoniae pneumonia.Results The serum levels of MIP-1α,APOC1,and CysLTs in case group were higher than those in the control group(P＜0.05).The serum levels of MIP-1α,APOC1,and CysLTs were higher in poor prognosis group compared with good prognosis group(P＜0.05).The levels of MIP-1α,APOC1,and CysLTs in the serum of case group were positively correlated with platelet count,mean platelet volume,white blood cell,neutrophil count,lactate dehydrogenase,erythrocyte sedimentation rate,C-reactive protein,and D-dimer(P＜0.05),and negatively correlated with AT-Ⅲ(P＜0.05).ROC analyses showed that the area under the curve(AUC)of MIP-1α,APOC1,and CysLTs combined was 0.881 in predicting prognosis,significantly higher than MIP-1α(Z=2.096,P=0.036),APOC1(Z=2.236,P=0.025),and CysLTs(Z=2.058,P=0.040)alone,with a sensitivity of 70.80％and specificity of 89.90％.Conclusions The levels of serum MIP-1α,APOC1,and CysLTs are elevated in children with severe M.pneumoniae pneumonia.Serum MIP-1α,APOC1,and CysLTs combined can provide higher value for predicting the prognosis of children with severe M.pneumoniae pneumonia.