Objective To investigate the characteristics of electrocardiogram changes during nocturnal asymptomatic hypoglycemia in type 2 diabetes mellitus(T2DM)patients and early diagnosis of cardiac autonomic neuropathy(CAN).Methods A total of 150 patients with T2DM who were admitted to our hospital from June 2015 to June 2022 were retrospectively selected and given 72 h dynamic blood glucose and dynamic electrocardiogram monitoring.According to whether asymptomatic hypoglycemia occurred at night,they were divided into hypoglycemia group(n=62)and non-hypoglycemia group(n=88).According to the Ewing experiment,150 T2DM patients with T2DM were divided into T2DM group(n=90)and CAN group(n=60).Results Compared with the non hypoglycemic group,the hypoglycemic group had an increase in DM duration,LF/HF(P<0.05),HbA1c,average blood glucose,collected heart rate deceleration force(DC),QT dispersion(QTD),end of peak T value(Tp-e),Tp-e/QT,percentage of beats with a difference of more than 50 ms between adjacent normal RR intervals(pNN50),root mean square difference between adjacent normal RR intervals(rMSSD),standard deviation of 24-hour normal sinus RR interval(SDNN),and standard deviation of mean normal RR interval every 5 minutes(SDANN)and the average heart rate decreased within 24 hours decreased(P<0.05).Logistic regression analysis showed that the duration of DM was a risk factor for CAN in T2DM patients,and DC,QTD,and pNN50 were protective factors for CAN in T2DM patients.The characteristic curve analysis of the participants showed that the area under the curve for predicting CAN was 0.811,0.842,0.786,0.801,and 0.886 for the DM duration,DC,QTD and pNN50 respectively.The combined diagnostic performance of these four items was the best.After internal verification,it was found that the model has good discrimination and accuracy.Conclusion T2DM patients with nocturnal asymptomatic hypoglycemia may exhibit elevated,ECG LF/HF and decreased DC,QTD,Tp-e,Tp-e/QT,pNN50,rMSSD,SDNN,SDANN,and 24-hour average heart rate decrease;DM duration,DC,QTD and pNN50 can serve as effective indicators for early diagnosis of CAN in T2DM patients.

Objective:To explore the diagnostic value of improved 18F-prostate specific membrane antigen (PSMA)-1007 PET-CT score (referred to as PSMA score) and multi parameter magnetic resonance imaging (mpMRI) prostate imaging reporting and data system (PI-RADS) score (referred to as PI-RADS score) for primary prostate cancer (PCa). Methods:A retrospective case series study was conducted. The imaging and clinical data of 134 suspected PCa patients underwent 18F-PSMA-1007 PET-CT and mpMRI examinations at Shanxi Province Cancer Hospital from July 2018 to May 2023 were collected. Pathological diagnosis showed 92 cases of PCa and 42 cases of benign prostatic lesions. The clinical and imaging parameters, as well as the distribution of patients with two scores, were compared between the two groups. The blind diagnosis of benign and malignant lesions was made based on the improved PSMA score (dividing 1 point into 1a and 1b points, 1b, 2 and 3 points were diagnosed as PCa), PI-RADS score (3, 4 and 5 points were diagnosed as PCa) and the combination of the two (diagnosed as PCa when either PSMA score ≥ 1b point or PI-RADS score ≥ 4 points was met). The indicators of the diagnostic efficiency of PSMA score, PI-RADS score and the combination of the two for PCa were calculated. Using pathological results as the gold standard, the receiver operating characteristic (ROC) curve of PSMA score, PI-RADS score and the combination of the two for diagnosing PCa was drawn, and the diagnostic efficiency of the 3 methods was analyzed. Results:The age, serum prostate-specific antigen, and maximum standard uptake value of PET-CT in the PCa group were higher than those in the benign prostatic lesion group, and the differences were statistically significant (all P < 0.05). The sensitivity, specificity, accuracy, false negative rate, false positive rate, positive predictive value, and negative predictive value of PSMA score for diagnosing PCa were 91.30% (84/92), 80.95% (34/42), 88.06% (118/134), 8.70% (8/92), 19.05% (8/42), 91.30% (84/92), and 80.95% (34/42), respectively; those of PI-RADS score were 93.48% (86/92), 61.90% (26/42), 83.58% (112/134), 61.90% (26/42), 38.10% (16/42), 84.31% (86/102), and 81.25% (26/32), respectively; those of the combination of the two were 97.83% (90/92), 88.10% (37/42), 94.78% (127/134), 2.17% (2/92), 11.90% (5/42), 94.74% (90/95), and 94.87% (37/39), respectively. The differences in specificity, accuracy, false negative rate, and false positive rate among the 3 methods were statistically significant (all P < 0.05). ROC curve analysis showed that the area under the curve of PSMA score, PI-RADS score and the combination of the two for diagnosing PCa were 0.930 (95% CI: 0.872-0.967), 0.935 (95% CI: 0.826-0.939) and 0.959 (95% CI: 0.910-0.986), respectively, and the differences between each two methods were statistically significant (all P < 0.05); the sensitivity of PSMA score, PI-RADS score and the combination of the two was 90.11%, 89.13% and 98.09%, and the specificity was 90.48%, 90.48% and 92.09%. Conclusions:Compared with the PI-RADS score, the improved PSMA score can improve the specificity and accuracy of PCa diagnosis, and decrease the false negative and false positive rates; the diagnostic efficiency of the combination of the two is superior.

With increasing aging， cognitive impairment in elderly coronary heart disease is a "disease group" with high morbidity and mortality in the senior population， which seriously affects the health and quality of life of the elderly. This paper takes the "cardio-cerebral circuit" as the basis of co-morbidity， and under the guidance of the cardio-cerebral homoeopathy， based on the temporal sequential characteristics of the evolution of the disease mechanism of cognitive impairment in elderly coronary heart disease， we construct a “disease-syndrome-phase” prevention and treatment strategy based on the time-sequential characteristics of the pathogenesis of the disease mechanism of "deficiency-blood stasis-toxicity"， from the perspective of pathogenicity of the disease mechanism in time-phase and the spatial multidimensionality of cardio-cerebral homoeopathy. The prevention and treatment strategy of the "disease-syndrome-phase" is constructed from the perspective of the temporal phase of the disease mechanism and the multidimensionality of the space of cardio-cerebral homoeopathy. In the earlier stage， "kidney deficiency and brain emptiness are the foundation"， in the attack stage， "turbid stasis and brain injury are the key"， and in the progression stage， "toxicity and brain damage are the changes". It is emphasized that replenishing the deficiency and benefiting the kidneys to restore the smooth flow of collaterals， eliminating blood stasis and removing turbidity to promote the enrichment of blood， and detoxifying and clearing the heart to tranquilize the spirit and benefit the brain， the spatiotemporal thinking of cognitive impairment of coronary heart disease in the elderly is initially constructed with the spatial dimension to identify the location of the disease， and the temporal dimension to determine the stage of the disease， which will provide a theoretical basis for the spatiotemporal diagnostic and treatments for the heart and brain co-morbidities of TCM.

OBJECTIVE To explore the potential geographic distribution of Pinellia Ternata (Thunb.) Breit. in Gansu province, clarify its habitat requirements, and provide a theoretical basis for rational cultivation. METHODS Based on 100 geographic distribution points of Pinellia Ternata (Thunb.) Breit. and 39 environmental variables (including 19 bioclimatic variables, 17 soil variables and 3 topographic variables), the maximum entropy model(MaxEnt) and ArcGIS geographic information system software were used to make the habitat suitable for its evaluation and classification of suitable areas, the result of Jackknife test was used to evaluate the environmental variables that affect the habitat of Pinellia Ternata (Thunb.) Breit., the area under the ROC curve(AUC) was used to evaluate the degree of reliability of the prediction results. RESULTS The AUC was 0.993, indicating that the prediction results of the MaxEnt model were reliable. Monthly average daily temperature difference, isotherm, standard deviation of seasonal variation of temperature, annual precipitation, the wettest month precipitation, the driest month precipitation, the driest season precipitation, the coldest season precipitation and altitude were the main environmental variables affecting the growth of Pinellia Ternata (Thunb.) Breit.. The suitable areas for Pinellia Ternata (Thunb.) Breit. in Gansu were mainly concentrated in Longnan, Tianshui and Pingliang, where the areas of high, medium and low suitable areas were 16 180.4, 15 413.96, 21 204.84 km2, respectively. CONCLUSION The research results can provide a theoretical reference for the protection and standardized cultivation of Pinellia Ternata (Thunb.) Breit. resources.

Objective:To investigate the effectiveness and safety of ultrasound-guided endovascular therapy for autogenous arteriovenous fistula (AVF) thrombosis.Methods:It was a single-center retrospective cohort study. Data of patients undergoing ultrasound-guided intravascular therapy due to AVF thrombosis in the First Hospital of Hebei Medical University from August 2018 to June 2021 were analyzed. According to different surgical procedures, the patients were divided into two groups. Patients treated with percutaneous transluminal angioplasty (PTA) + drilling thrombectomy were in group A, and patients treated with PTA only were in group B. After 1 year of follow-up, the surgical technique success rate, primary patency rate, secondary patency rate and complications were compared between the two groups.Results:A total of 152 patients were enrolled, including 74 in group A and 78 in group B. There were no significant differences in gender, age, proportion of patients with diabetes and hypertension, and thrombosis time of AVF between the two groups (all P>0.05). Compared with group B, the diameter and length of thrombus in group A were larger [13.0(9.0, 16.0) mm vs. 6.0(5.0, 6.5) mm, Z=-9.362, P<0.001; 12(8, 15) cm vs. 3(3, 4) cm, Z=-10.061, P<0.001], and the establishment time of AVF was longer [5(2, 7) years vs. 2(1, 5) years, Z=-2.698, P=0.007]. Among the overall patients, the success rate of surgery was 96.7% (147/152), and the success rate of surgery was 95.9% (71/74) in group A and 97.4% (76/78) in group B respectively, with no statistical difference ( χ2=0.004, P=0.952). Kaplan-Meier survival analysis showed that, overall, the primary patency rate at 3rd, 6th and 12th month after operation was 87.1%, 71.4% and 56.6%, and the secondary patency rate was 97.1%, 96.4% and 94.1%, respectively. The primary patency rate of group A at 3rd, 6th and 12th month was 82.4%, 66.7% and 53.6%, and the secondary patency rate was 95.7%, 94.2% and 89.7%, respectively. The primary patency rate of group B at 3rd, 6th and 12th month was 91.5%, 73.2% and 59.7%, and the secondary patency rate was 98.6%, 98.6% and 98.5%, respectively. There was no significant difference in the primary and secondary patency rate between group A and group B at 3rd, 6th and 12th month (all P>0.05). The duration of operation in group A was longer than that in group B [2.0(1.9, 2.0) h vs. 2.0(1.0, 2.0) h, Z=-5.181, P<0.001], but no serious complications occurred in both groups. Conclusion:The two surgical methods are effective, safe and reliable in the treatment of AVF thrombosis, and have high clinical application value.

Objective:To observe the clinical efficacy of pressing-kneading manipulation combined with herb-insulated moxibustion at Shuidao(ST28)for postpartum urinary retention after labor analgesia and its effect on bladder urination function. Methods:A total of 154 patients with postpartum urinary retention after labor analgesia were randomly divided into a Western medication group and a herb-insulated moxibustion group,with 77 cases in each group.In the Western medication group,neostigmine sulfate was injected into Zusanli(ST36).In the herb-insulated moxibustion group,after pressing-kneading manipulation at Shuidao(ST28),herb-insulated moxibustion was applied to Shuidao(ST28)with self-made Tong Quan San.Both groups were treated once,and the clinical efficacy was evaluated 5 h after treatment.The first urination time,first urination volume,average urinary flow rate,bladder residual urine volume,hospitalization days,and costs were recorded. Results:The total effective rate and markedly effective rate of the herb-insulated moxibustion group were higher than those of the Western medication group(P<0.05),the time to the first urination and residual urine volume in the bladder of the herb-insulated moxibustion group were shorter or smaller than those of the Western medication group(P<0.01),the first urination volume and average urine flow rate of the herb-insulated moxibustion group were larger than those of the Western medication group(P<0.01).There were no significant differences in the hospitalization days and costs between the two groups(P>0.05). Conclusion:Pressing-kneading manipulation combined with herb-insulated moxibustion at Shuidao(ST28)can effectively treat postpartum urinary retention after labor analgesia and improve bladder urination function.

Objective:To explore the application effect of situation comedy teaching combined with peer teaching in clinical practice teaching of undergraduate nursing students.Methods:A total of 96 undergraduate nursing students who practiced in a first-class hospital at grade 3 in 2019 were randomly divided into the observation group and the control group, with 48 nursing students in each group. The control group adopted clinical teaching mode, including group theory teaching and group operation demonstration. On the basis of this, the observation group additionally adopted the clinical teaching mode of situation comedy teaching combined with peer teaching. The differences between the two groups in the assessment of nursing knowledge and skills assessment, independent learning ability and teaching satisfaction were observed. SPSS 20.0 software was used for t-test. Results:After the implementation of clinical teaching, the scores of nursing comprehensive ability of nursing students in the observation group (87.71 ± 5.11) were higher than those in the control group (78.47±6.24) ( P < 0.05). The independent learning ability of nursing students in the observation group (98.80±10.61) was significantly higher than that in the control group (74.47±9.83), and the difference was statistically significant ( P < 0.05). The score of teaching satisfaction in the observation group (2.83±7.07) was significantly higher than that in the control group (50.17±6.75), and the difference was statistically significant ( P < 0.05). Conclusion:The application of situation domedy teaching combined with peer teaching in the clinical teaching of undergraduate nursing students can improve their independent learning ability and clinical practice ability. Meanwhile, the process of teachers and students participating in situational experience and peer analysis and discussion can increase the teacher-student interaction, and improve the satisfaction of nursing students with clinical teaching.

ObjectiveBased on network pharmacology and molecular docking techniques， the mechanism of essential oil from Chimonanthus nitens leaves （CLO） in the treatment of acute lung injury （ALI） was predicted， and a rat model of ALI was established to verify the mechanism of CLO. MethodThe composition of CLO was determined by gas chromatography-mass spectrometry （GC-MS）. The component targets were obtained from PharmMapper and SwissTargetPrediction databases， ALI-related targets were obtained from GeneCards， Online Mendelian Inheritance in Man （OMIM） and DisGeNET， cross-over analysis with differential expressed genes （DEGs） of ALI obtained from Gene Expression Omnibus （GEO） on the Venny 2.1.0 platform yielded potential anti-ALI targets of CLO. Protein-protein interaction （PPI） analysis of potential targets was carried out by STRING 11.5. The tissue expression profiles of potential targets were obtained from the National Center for Biotechnology Information （NCBI） and the target tissue distribution maps were constructed. Potential targets were analyzed for Gene Ontology （GO） function and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment by RStudio 4.0.0 software. Composition-target-pathway network was constructed by Cytoscape 3.9.1 software， and key components and pathways were screened out and verified by molecular docking. ALI model was established by lipopolysaccharide （LPS） induction， levels of interleukin （IL）-6 and tumor necrosis factor （TNF）-α in serum of rats were measured， the expression levels of IL-17 protein in the lung tissue of ALI rats were analyzed by immunohistochemistry. ResultA total of 19 components of CLO were identified by GC-MS， and 18 potential targets were obtained by target screening. After PPI analysis， 15 target proteins with interaction relationship were obtained， further analysis showed that they were highly expressed in lung and thymus. The network diagram of component-target-pathway was analyzed to obtain the key components， including bornyl acetate， linalool， elemol， geranyl isobutyrate， and the core targets of matrix metalloproteinase 13 （MMP13）， S100 calcium binding protein A9 （S100A9）， spleen tyrosine kinase （SYK）， as well as the main signaling pathways， such as IL-17 and TNF. The results of molecular docking showed that the key components were stably bound to MMP13 and S100A9 of IL-17 signaling pathway. The results of pharmacological experiment confirmed that CLO could significantly inhibit the expression of IL-6 and TNF-α in serum of ALI rats， and decrease the expression of IL-17 protein in lung tissue of ALI rats. ConclusionCLO can achieve the therapeutic effect on ALI and protect lung tissue， the mechanism may be related to the decrease of the expression of IL-6 and TNF-α in serum and the inhibition of the activation of IL-17 signaling pathway in lung tissue of ALI rats.

Diabetic cardiomyopathy refers to dysfunction of cardiac muscle in patients with diabetes that cannot be directly ascribed to hypertension， coronary heart disease or other defined cardiac abnormalities. Imbalance in metabolic flexibility is the underlying cause of diabetic cardiomyopathy， which is manifested as distorted nutrient sensing， slow substrate switching， and impaired energy homeostasis. In the case of diabetes/insulin resistance， cardiac fatty acid oxidation increases while glucose oxidation decreases， resulting in the imbalance in cardiac metabolic flexibility. Thus， the heart fails to switch substrates depending on the changes （taking food/fasting， rest/exercise） and the energy production in cardiomyocytes reduced， causing cardiac dysfunction. Moreover， the excessive cardiac fatty acid fails to be degraded by the mitochondrial β oxidation， triggering cardiac lipid accumulation and reduction in glucose oxidation. Therefore， the glucose in the pentose phosphate （PPP） and the hexosamine biosynthetic pathway （HBP） increases and the production of advanced glycation end products rises， inducing glycolipotoxicity. The intermediates of abnormal substrate metabolism cause oxidative stress， inflammation， mitochondrial dysfunction and further result in impaired myocardial function. Qi and blood are the main functional substances for the normal functioning of the body. Qi and blood harmonize and work together to defend against external pathogen， while disharmony of blood and Qi will induce the production of various pathological products that lead to the occurrence of diseases. The function and regulation of Qi-Blood movement are similar to those of metabolism. Qi deficiency and blood stasis， Qi stagnation and blood stasis， and other "blood-Qi disharmony" types run through the whole process of diabetic cardiomyopathy， and "blood-Qi disharmony" will affect systemic substrate metabolism and lead to impaired energy metabolism. By systematically explaining the relationship between "blood-Qi disharmony" and "metabolic flexibility" in diabetic cardiomyopathy， we provide scientific research and clinical formulation ideas for targeting "metabolic flexibility" in the prevention of diabetic cardiomyopathy with Qi-replenishing and Blood-activating medicinals.

In order to expand the breadth and depth of pharmaceutical services, in March 2022, a tertiary hospital opened a physician-pharmacist joint clinic based on clinical specialty clinics. The hospital formulated a fixed outpatient scheduling system, clarified service targets, established outpatient treatment processes and quality management systems, and standardized pharmacist communication models, to provide patients with " one-stop" standardized pharmaceutical services. As of December 2022, the pharmaceutical joint outpatient service had opened more than 100 consultations and served 1 709 patients. This practice provided reference for promoting the high-quality development of pharmaceutical services in medical institutions in China.