Objective:To evaluate the efficacy and safety of a Chinese herbal mask in the treatment of melanized-type melasma by stereological measurements.Methods:A randomized, controlled, evaluator- and statistician-blind clinical study was conducted. A total of 116 patients with melasma who met the inclusion and exclusion criteria were selected and equally divided into two groups by using a random number table method, with 58 patients in each group. The treatment group received topical treatment with a Chinese herbal mask once a night, while the control group received topical hydroquinone cream in the morning and evening twice daily. The course of treatment lasted 12 weeks, with follow-ups every 4 weeks, and an additional follow-up was performed 12 weeks after discontinuation of treatment. A facial image analyzer and a reflectance confocal microscopy (RCM) were used to collect images before and after treatment. Melasma area and severity index (MASI) scores and RCM scores served as outcome measures, and stereological measurement methods were employed to compare scores before and after treatment; response rates and recurrence rates were calculated, and adverse reactions were observed and recorded. Statistical analyses were performed using the chi-square test and t test. Results:A total of 54 patients in the treatment group and 47 patients in the control group completed the study. After 4- and 8-week treatment, there were no significant differences in MASI scores or RCM scores between the two groups (all P > 0.05) ; after 12-week treatment, the MASI scores and RCM scores were significantly lower in the treatment group (2.91 ± 1.16, 5.48 ± 1.60, respectively) than in the control group (3.99 ± 2.03, 6.66 ± 1.88, t = -3.32, -3.37, respectively, both P < 0.01). After the end of treatment, there was no significant difference in the response rate between the treatment group (44/54, 81.5%) and the control group (34/47, 72.3%; χ2 = 0.12, P > 0.05). Twelve weeks after discontinuation of treatment, 2 patients (3.7%) relapsed in the treatment group, while 15 (31.9%) relapsed in the control group, showing a significant difference in recurrence rates between the two groups ( χ2 = 12.34, P < 0.01). Adverse reactions occurred in 2 patients (3.7%) in the treatment group and 6 (11.5%) in the control group, and there was no significant difference in the incidence of adverse reactions between the two groups ( χ2 = 1.34, P > 0.05) . Conclusions:The Chinese herbal mask was safe and effective in the treatment of melanized-type melasma. The application of the facial image analyzer and RCM technology in combination with stereological measurement methods has certain value in reducing the subjectivity in efficacy evaluation for melasma.

Objective To investigate the current status of cleaning,disinfection,and sterilization management of dental instruments in medical institutions in Henan Province,analyze potential issues in hospital infection control,and propose targeted nursing strategies.Methods A convenience sampling method was used to survey the cleaning,disinfection,and sterilization management of dental instruments in 352 medical institutions in Henan Province from February to April 2024.A self-made questionnaire was designed,covering aspects such as the handling model and personnel configuration for dental instruments,training for cleaning,disinfection,and sterilization personnel,configuration and maintenance of cleaning and disinfection equipment,use and management of small pressure steam sterilizers,and reprocessing status of dental instruments.Results A total of 352 questionnaires were distributed,with 348 valid responses.Among the 34 primary medical institutions,only 10(29.41％)had a centralized cleaning,disinfection,and sterilization model for dental instruments;13(38.24％)had dedicated personnel for cleaning,disinfection,and sterilization of dental instruments;25(73.53％)were equipped with pressure water guns.Compari-sons among medical institutions of different levels showed statistically significant differences(P＜0.001).In the 348 medical institutions,194(55.75％)arranged pre-job training for nursing personnel;143(41.09％)performed mainte-nance on cleaning and disinfection equipment once a year;52(14.94％)did not perform pre-treatment on contaminated dental instruments after use.Among the 104 institutions using small pressure steam sterilizers,21(20.19％)used Type N small pressure steam sterilizers.Conclusion The centralized management rate of dental instruments and the basic equipment configuration rate in primary medical institutions in Henan Province are relatively low.There are issues such as insufficient personnel training,neglect of equipment maintenance,improper management of small pressure steam sterilizer usage,and incomplete reprocessing procedures in medical institutions at all levels.It is recommended that nursing managers further strengthen the training of nurses in the disinfection supply center,standardize the cleaning,disinfection,and sterilization workflow for dental instruments,in order to prevent and control hospital infections.

Objective:To understand the potential characteristics of decision-making preparation in outpatient hypertensive patients based on latent profile analysis, to identify the influencing factors of different categories of decision-making preparation levels, and to explore the performance of different decision-making preparation types in facilitation of patients involvement in treatment decision-making.Methods:Through a cross-sectional study, 350 hypertensive patients attending outpatient clinics in five different types of healthcare institutions (general hospitals, specialised hospitals and community hospitals) in Tianjin during January to May 2024 who met the inclusion and exclusion criteria were selected by the convenience sampling method as study subjects. General Information Questionnaires, Preparation for Decision Making Scale, and Facilitation of Patient Involvement Scale were used for investigation.Results:Totally 350 valid questionnaires [178 males and 172 females aged 25-89(57.24 ± 13.39)years old] were collected. The decision-making preparation score of outpatient hypertensive patients was (64.19 ± 18.69). The latent profile analysis results showed that the decision-making preparation of outpatient hypertensive patients could be divided into three potential categories: decision-making information scarcity type accounted for 20.0%(70/350), decision-making balance negotiation type accounted for 39.7%(139/350), and decision-making preparation adequacy type accounted for 40.3%(141/350). The results of multiple Logistic regression analysis showed that age, medical insurance type, occupation, and children′s condition were the influencing factors for the potential categories of decision-making preparation in outpatient hypertensive patients (all P<0.05). Age [less than 35 years old: OR(95% CI)=0.127(0.020-0.796)], occupation [on the job: OR(95% CI)=2.010 (1.034-3.906)], were the influencing factors of decision-making balance negotiation group (all P<0.05). Medical insurance type [basic medical insurance for urban employees: OR(95% CI)=0.372(0.193-0.720)], occupation [on the job: OR(95% CI)=2.500(1.270-4.920)], children′s condition[junior and senior high school: OR(95% CI)=0.391(0.190-0.802)] were the influencing factors of decision-making preparation adequacy group (all P<0.05). Conclusions:The level of promoting patient participation among outpatients with hypertension is relatively high, and there are differences in the perceived degree of promoting patient participation among patients with different types of decision preparation.It is recommended that medical staff provide decision-making related information based on the characteristics of different decision-making preparation categories of patients, encourage patients to actively participate in decision-making, and construct targeted decision support plans.

Objective:To evaluate the efficacy and safety of a Chinese herbal mask in the treatment of melanized-type melasma by stereological measurements.Methods:A randomized, controlled, evaluator- and statistician-blind clinical study was conducted. A total of 116 patients with melasma who met the inclusion and exclusion criteria were selected and equally divided into two groups by using a random number table method, with 58 patients in each group. The treatment group received topical treatment with a Chinese herbal mask once a night, while the control group received topical hydroquinone cream in the morning and evening twice daily. The course of treatment lasted 12 weeks, with follow-ups every 4 weeks, and an additional follow-up was performed 12 weeks after discontinuation of treatment. A facial image analyzer and a reflectance confocal microscopy (RCM) were used to collect images before and after treatment. Melasma area and severity index (MASI) scores and RCM scores served as outcome measures, and stereological measurement methods were employed to compare scores before and after treatment; response rates and recurrence rates were calculated, and adverse reactions were observed and recorded. Statistical analyses were performed using the chi-square test and t test. Results:A total of 54 patients in the treatment group and 47 patients in the control group completed the study. After 4- and 8-week treatment, there were no significant differences in MASI scores or RCM scores between the two groups (all P > 0.05) ; after 12-week treatment, the MASI scores and RCM scores were significantly lower in the treatment group (2.91 ± 1.16, 5.48 ± 1.60, respectively) than in the control group (3.99 ± 2.03, 6.66 ± 1.88, t = -3.32, -3.37, respectively, both P < 0.01). After the end of treatment, there was no significant difference in the response rate between the treatment group (44/54, 81.5%) and the control group (34/47, 72.3%; χ2 = 0.12, P > 0.05). Twelve weeks after discontinuation of treatment, 2 patients (3.7%) relapsed in the treatment group, while 15 (31.9%) relapsed in the control group, showing a significant difference in recurrence rates between the two groups ( χ2 = 12.34, P < 0.01). Adverse reactions occurred in 2 patients (3.7%) in the treatment group and 6 (11.5%) in the control group, and there was no significant difference in the incidence of adverse reactions between the two groups ( χ2 = 1.34, P > 0.05) . Conclusions:The Chinese herbal mask was safe and effective in the treatment of melanized-type melasma. The application of the facial image analyzer and RCM technology in combination with stereological measurement methods has certain value in reducing the subjectivity in efficacy evaluation for melasma.

Objective To investigate the current status of cleaning,disinfection,and sterilization management of dental instruments in medical institutions in Henan Province,analyze potential issues in hospital infection control,and propose targeted nursing strategies.Methods A convenience sampling method was used to survey the cleaning,disinfection,and sterilization management of dental instruments in 352 medical institutions in Henan Province from February to April 2024.A self-made questionnaire was designed,covering aspects such as the handling model and personnel configuration for dental instruments,training for cleaning,disinfection,and sterilization personnel,configuration and maintenance of cleaning and disinfection equipment,use and management of small pressure steam sterilizers,and reprocessing status of dental instruments.Results A total of 352 questionnaires were distributed,with 348 valid responses.Among the 34 primary medical institutions,only 10(29.41％)had a centralized cleaning,disinfection,and sterilization model for dental instruments;13(38.24％)had dedicated personnel for cleaning,disinfection,and sterilization of dental instruments;25(73.53％)were equipped with pressure water guns.Compari-sons among medical institutions of different levels showed statistically significant differences(P＜0.001).In the 348 medical institutions,194(55.75％)arranged pre-job training for nursing personnel;143(41.09％)performed mainte-nance on cleaning and disinfection equipment once a year;52(14.94％)did not perform pre-treatment on contaminated dental instruments after use.Among the 104 institutions using small pressure steam sterilizers,21(20.19％)used Type N small pressure steam sterilizers.Conclusion The centralized management rate of dental instruments and the basic equipment configuration rate in primary medical institutions in Henan Province are relatively low.There are issues such as insufficient personnel training,neglect of equipment maintenance,improper management of small pressure steam sterilizer usage,and incomplete reprocessing procedures in medical institutions at all levels.It is recommended that nursing managers further strengthen the training of nurses in the disinfection supply center,standardize the cleaning,disinfection,and sterilization workflow for dental instruments,in order to prevent and control hospital infections.

Objective:To understand the potential characteristics of decision-making preparation in outpatient hypertensive patients based on latent profile analysis, to identify the influencing factors of different categories of decision-making preparation levels, and to explore the performance of different decision-making preparation types in facilitation of patients involvement in treatment decision-making.Methods:Through a cross-sectional study, 350 hypertensive patients attending outpatient clinics in five different types of healthcare institutions (general hospitals, specialised hospitals and community hospitals) in Tianjin during January to May 2024 who met the inclusion and exclusion criteria were selected by the convenience sampling method as study subjects. General Information Questionnaires, Preparation for Decision Making Scale, and Facilitation of Patient Involvement Scale were used for investigation.Results:Totally 350 valid questionnaires [178 males and 172 females aged 25-89(57.24 ± 13.39)years old] were collected. The decision-making preparation score of outpatient hypertensive patients was (64.19 ± 18.69). The latent profile analysis results showed that the decision-making preparation of outpatient hypertensive patients could be divided into three potential categories: decision-making information scarcity type accounted for 20.0%(70/350), decision-making balance negotiation type accounted for 39.7%(139/350), and decision-making preparation adequacy type accounted for 40.3%(141/350). The results of multiple Logistic regression analysis showed that age, medical insurance type, occupation, and children′s condition were the influencing factors for the potential categories of decision-making preparation in outpatient hypertensive patients (all P<0.05). Age [less than 35 years old: OR(95% CI)=0.127(0.020-0.796)], occupation [on the job: OR(95% CI)=2.010 (1.034-3.906)], were the influencing factors of decision-making balance negotiation group (all P<0.05). Medical insurance type [basic medical insurance for urban employees: OR(95% CI)=0.372(0.193-0.720)], occupation [on the job: OR(95% CI)=2.500(1.270-4.920)], children′s condition[junior and senior high school: OR(95% CI)=0.391(0.190-0.802)] were the influencing factors of decision-making preparation adequacy group (all P<0.05). Conclusions:The level of promoting patient participation among outpatients with hypertension is relatively high, and there are differences in the perceived degree of promoting patient participation among patients with different types of decision preparation.It is recommended that medical staff provide decision-making related information based on the characteristics of different decision-making preparation categories of patients, encourage patients to actively participate in decision-making, and construct targeted decision support plans.

Objective To investigate the clinical effect of Mudan Granules combined with pentoxifylline in the treatment of type 2 diabetes mellitus (T2DM) with early renal disease and analyze its impact on the Toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) signaling pathway. Methods A total of 164 patients with T2DM and early renal disease admitted to the Second People's Hospital of Hunan Province between May 2022 and October 2023 were enrolled and randomly divided into observation group(n=82) and control group (n=82) using a random number table in a 1-to-1 ratio. The control group received pentoxifylline treatment, while the observation group received Mudan granules combined with pentoxifylline. The clinical effects and changes in renal function indicators[serum creatinine (SCr), urea nitrogen, urinary albumin-to-creatinine ratio (UACR)], TLR4/NF-κB signaling pathway indicators (TLR4, MyD88, NF-κB mRNA), and inflammation and oxidative stress indicators [C-reactive protein (CRP), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total antioxidant capacity (TAC), and transforming growth factor β1 (TGF-β1)] before and after treatment were compared between the two groups. Results The total effective rate in the observation group was 97.56%, which was higher than 89.02% in the control group (P<0.05). At 6 and 12 weeks after treatment, the levels of SCr, urea nitrogen, and UACR in both groups decreased compared with those before treatment, and the levels of these indicators in the observation group were lower than those in the control group (P<0.05). At 6 and 12 weeks after treatment, the levels of TLR4, MyD88, and NF-κB mRNA in both groups decreased compared with those before treatment, and the levels of these indicators in the observation group were lower than those in the control group (P<0.05). At 6 and 12 weeks after treatment, the levels of GSH-PX and TAC in both groups increased, while the levels of CRP, MDA, and TGF-β1 decreased compared with those before treatment. The levels of GSH-PX and TAC in the observation group were higher than those in the control group, while the levels of CRP and MDA were lower (P<0.05). Conclusion Mudan Granules combined with pentoxifylline in the treatment of T2DM with early renal disease can improve renal function to a certain extent, regulate the TLR4/NF-κB signaling pathway, and reduce inflammation and oxidative stress responses, which is beneficial for disease control.

Objective: To compare the efficacy and safety of combining diosmin with Jiuhua hemorrhoid suppository versus diosmin alone for the treatment of hemorrhoid hemorrhage. Methods: The Jiuhua hemorrhoid suppository study was conducted in 10 medical centers across China from April 1, 2019 to June 30, 2020. Patients with hemorrhoid bleeding were randomized in a ratio of 1 : 1 to either receive Jiuhua hemorrhoid suppository and diosmin tablets (the study group) or diosmin tablets alone (the control group). The suppository was used once a day after defecation or at bedtime after rinsing the anus with warm water. Diosmin tablets were administered only once a day (0.9 g). The primary endpoint of the study was the assessment of hemorrhoid bleeding relief 7 ± 2 days after treatment, classified as “very effective” “effective” and “ineffective”. The secondary endpoint included the evaluation of pain alleviation using the visual analogue scale (VAS, with scores ranging from 0 to 10) and edema (with scores ranging from 0 to 3). The safety of the two treatment regimens was evaluated 14 ± 2 days after drug administration. Results: The full analysis set (FAS) comprised 107 participants in the study group and 111 in the control group, while the per-protocol set (PPS) included 106 participants in the study group and 111 in the control group. In terms of hemorrhoid bleeding, the proportion of very effective and effective cases in the study group were significantly higher than that in the control group [106 (99.06%) vs. 91 (81.98%), P < 0.0001] in the FAS, and the PPS results [105 (99.06%) vs. 91 (81.98%), P < 0.0001] were comparable to the FAS results. The pain VAS scores at day 7 after treatment were comparable between the two groups (0.80 ± 1.17 vs. 0.80 ± 1.20, P = 0.2177). The majority of the participants in both groups had an edema score of 0 at day 7 after treatment [96 (89.72%) vs. 99 (91.67%), P = 0.370 5]. Adverse events (AEs) occurred in 9 patients (8.4%) in the study group and 3 patients (2.7%) in the control group. In addition, 5 AEs in the study group and 1 AE in the control group were possibly in association with the study drug. Conclusion Compared with the administration of diosmin oral tablets alone, the addition of Jiuhua hemorrhoid suppository to the tablets demonstrates enhanced efficacy in addressing hemorrhoid bleeding, with satisfactory patient adherence and acceptable safety.

There are few clinical reports on the diagnosis and treatment of upper urinary tract stones secondary to urinary diversion. This study included 30 patients with upper urinary tract stones secondary to urinary diversion, and all of which were successfully managed. The individualized treatment with the ureteroscopy and/or percutaneous nephrolithotripsy with antegrade, retrograde, or a combination of antegrade and retrograde is safe and feasible.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.