Objective:To investigate the effect of sanguinarine(SAG)on the intestinal epithelial barrier in septic rats and to explore the potential mechanism initially.Methods:Rats were divided into Sham group,CLP group,low-dose SAG group(L-SAG group),medium-dose SAG group(M-SAG group)and high-dose SAG group(H-SAG group)according to the random number table method,10 rats in each group.The rat model of sepsis was induced by cecum ligation puncture(CLP)method.HE staining was used to observe the pathological damage of intestinal epithelium.Serum DAO activity was detected by diamine oxidase(DAO)kit.Detec-tion of urinary lactose/mannitol(L/M)ratio by high performance liquid chromatography.Detection of serum TNF-α,IL-6 and IL-1β levels by ELISA.Protein expression levels in intestinal epithelial tissues were detected by Western blot.Results:The intestinal mucosa was intact and the intestinal villi were neatly arranged of rats in the Sham group;the intestinal mucosa of CLP group showed congestion and edema,inflammatory cell infiltration,irregular arrangement of intestinal villi,and enlarged villi gap;the pathological damage of intestinal mucosa in M-SAG group and H-SAG group were reduced to different degrees compared with the CLP group.Chiu's score,se-rum DAO activity and urinary L/M ratio were significantly higher in the CLP group compared with the Sham group;Chiu's score,se-rum DAO activity and urinary L/M ratio were significantly lower in the M-SAG and H-SAG groups compared with the CLP group(P<0.05).The serum TNF-α,IL-6 and IL-1β levels were significantly lower in the CLP group than in the Sham group,while the serum TNF-α,IL-6 and IL-1β levels were significantly higher in the M-SAG and H-SAG groups than in the CLP group(P<0.05).Claudin-3,ZO-1 and ocludin protein expressions were significantly lower in the intestinal epithelium of rats in the CLP group compared with the Sham group,while MLCK,MLC and p-MLC protein expressions were significantly increased.Compared with the CLP group,Claudin-3,ZO-1 and occludin protein expressions were significantly increased in the intestinal epithelium of rats in the M-SAG and H-SAG groups,while MLCK,MLC and p-MLC protein expressions were significantly decreased(P<0.05).Conclusion:SAG can reduce in-testinal barrier damage,inhibit intestinal barrier permeability,and protect intestinal barrier integrity in septic rats,which is at least partially achieved by inhibiting MLCK-MLC signaling pathway activation.

Objective:To investigate the effect of sanguinarine(SAG)on the intestinal epithelial barrier in septic rats and to explore the potential mechanism initially.Methods:Rats were divided into Sham group,CLP group,low-dose SAG group(L-SAG group),medium-dose SAG group(M-SAG group)and high-dose SAG group(H-SAG group)according to the random number table method,10 rats in each group.The rat model of sepsis was induced by cecum ligation puncture(CLP)method.HE staining was used to observe the pathological damage of intestinal epithelium.Serum DAO activity was detected by diamine oxidase(DAO)kit.Detec-tion of urinary lactose/mannitol(L/M)ratio by high performance liquid chromatography.Detection of serum TNF-α,IL-6 and IL-1β levels by ELISA.Protein expression levels in intestinal epithelial tissues were detected by Western blot.Results:The intestinal mucosa was intact and the intestinal villi were neatly arranged of rats in the Sham group;the intestinal mucosa of CLP group showed congestion and edema,inflammatory cell infiltration,irregular arrangement of intestinal villi,and enlarged villi gap;the pathological damage of intestinal mucosa in M-SAG group and H-SAG group were reduced to different degrees compared with the CLP group.Chiu's score,se-rum DAO activity and urinary L/M ratio were significantly higher in the CLP group compared with the Sham group;Chiu's score,se-rum DAO activity and urinary L/M ratio were significantly lower in the M-SAG and H-SAG groups compared with the CLP group(P<0.05).The serum TNF-α,IL-6 and IL-1β levels were significantly lower in the CLP group than in the Sham group,while the serum TNF-α,IL-6 and IL-1β levels were significantly higher in the M-SAG and H-SAG groups than in the CLP group(P<0.05).Claudin-3,ZO-1 and ocludin protein expressions were significantly lower in the intestinal epithelium of rats in the CLP group compared with the Sham group,while MLCK,MLC and p-MLC protein expressions were significantly increased.Compared with the CLP group,Claudin-3,ZO-1 and occludin protein expressions were significantly increased in the intestinal epithelium of rats in the M-SAG and H-SAG groups,while MLCK,MLC and p-MLC protein expressions were significantly decreased(P<0.05).Conclusion:SAG can reduce in-testinal barrier damage,inhibit intestinal barrier permeability,and protect intestinal barrier integrity in septic rats,which is at least partially achieved by inhibiting MLCK-MLC signaling pathway activation.

Objective: To elucidate the association between biorhythm disorders and health risk behaviors in adolescence, so as to provide reference for appropriate interventions. Methods: From March to April 2023, 2 381 adolescents in Shanghai were selected as research objects using convenience sampling and stratified random cluster sampling methods. The Self rating Questionnaire of Biological Rhythm Disorders for Adolescents (SQBRDA) and the self report health risk behaviors questionnaire were used to investigate the status of adolescent biorhythm disorders and nine kinds of health risk behaviors, while a multivariate Logistic regression model was employed to analyze the association between the two variables. Results: The average SQBRDA score was (68.25±0.42) The incidence and detection rates of health risk behaviors in the groups with no co occurrence, mild co occurrence, moderate co occurrence, and severe co occurrence were 234(9.83%), 1 176(49.39%), 830(34.86%) and 141(5.92%), respectively. The total SQBRDA score was positively correlated with the risk of co occurrence of health risk behaviors. The risk of mild co occurrence, moderate co occurrence, and severe co occurrence of health risk behaviors was 9.05 times (95% CI =4.25-19.15, P <0.01), 44.55 times (95% CI =20.75-96.05, P <0.01) and 110.05 times (95% CI =40.65-297.95, P <0.01) higher, respectively, among adolescents with higher scores of biorhythm disorders compared to adolescents with lower scores of biorhythm disorders. Conclusions Health risk behaviors among adolescents in Shanghai draw attention to a serious phenomenon whereby biorhythm disorders are positively correlated with the risk of co occurrence. Comprehensive interventions aimed at addressing adolescent health risk behaviors should focus on regulating biorhythm disorders.

Objective:To identify serum metabolic markers for early prediction and diagnosis of gestational diabetes mellitus (GDM).Methods:A retrospective case-control study was conducted.The study subjects were from pregnant women enrolled in the Birth Cohort Study of the Women′s Hospital, Zhejiang University, from1 November 2018 to 30 March 2020.100 cases of GDM (GDM group, Age 36.03±3.91) and 150 non-GDM pregnant women matched for clinical information (control group, Age35.49±3.46) were retrospectively selected for the study. Fasting serum samples were collected at 15-20 weeks of gestation (prior to GDM diagnosis, T1 period) and 24-28 weeks of gestation (during GDM diagnosis, T2 period). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to quantify GDM-related serum metabolic small molecules, including 1, 5-anhydroglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine. These molecules, along with basic clinical information (age, gestational week, BMI) and standard biochemical indicators (FPG), were used to develop predictive models for the early detection of GDM at T1 and the diagnosis of GDM at T2. Statistical analysis was performed using t-tests or Mann-Whitney U-tests.Result:The results of the targeted quantitative validation study indicate: At the T1 stage, the level of 1, 5-anhydroglucitol was found to be significantly lower ( P=0.001) in the GDM group compared to the control group. Conversely, the level of isoleucine was significantly higher ( P=0.027) in the GDM group. There were no significant differences in the levels of 3-hydroxybutyrate and phenylalanine between the two groups ( P>0.05). The combination of the 4 metabolites yielded the highest predictive value (AUC) for GDM at T1, with an AUC of 0.670 (95% CI: 0.602-0.739), P<0.001.At the T2 stage, the GDM group had significantly lower levels of 1, 5-anhydroglucitol ( P<0.05) and significantly higher levels of 3-hydroxybutyric acid and isoleucine ( P<0.05) than the control group, with no significant differences in phenylalanine levels ( P=0.626). The combination of the four metabolites had the highest diagnostic value (AUC) for GDM, 0.717 (95% CI 0.651-0.783), P<0.001.The analysis of seven different combinations of GDM prediction/diagnostic models created by combining four metabolites with basic clinical information and routine biochemical indicators showed: We found that the AUC value of the GDM diagnostic model built with FPG, BMI, pre-pregnancy BMI, age, gestational week, and the 4 metabolite indicators in T2 stage was the best, 0.794 (95% CI 0.736-0.851), P<0.001, with a sensitivity of 72%;The best AUC value for the GDM prediction model built with the same indicators at T1 was 0.711(95% CI 0.646-0.776), P<0.001, with a sensitivity of 77%. Conclusions:Four metabolic small molecules, 1, 5-anhydroxyglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine, were integrated with clinical indicators (FPG) and clinical information (age, gestational week, BMI) to develop a predictive model for GDM at gestation (T1) and a diagnostic model for GDM at gestation (T2), demonstrating promising clinical prediction and diagnostic capabilities. 1, 5-Anhydroglucitol, 3-hydroxybutyric acid, phenylalanine, and isoleucine show potential as valuable markers for the prediction and diagnosis of GDM.

Objective To analyze the applied condition of ovary function suppression ( OFS) before and after joint analysis of TEXT and SOFT trials and SOFT trial, and to identify the relevant factors of OFS usage. Methods The analysis was performed in premenopausal women with hormone receptor ( HR ) positive breast cancer receiving surgical treatment from Apr 2013 to Oct 2015 in Ruijin Hospital, Shanghai Jiaotong University School of Medicine. Adjuvant treatment strategy was made in the multidisciplinary team ( MDT) meetings. We analyzed the applied condition of OFS before and after joint analysis, SOFT trial and its relevant factors. Results Among 454 patients, 114 (25.1%) patients received OFS. Before the results of joint analysis came out, all the patients ( 38/38) received OFS together with tamoxifen ( TAM);after the results came out, clinicians began to put OFS with exemestane into practice, among 76 patients, 41(53.9%) patients received OFS with exemestane while 35 (46.1%) patients received OFS together with TAM. Before the results of SOFT trial came out, 71 out of 310 (22.9%) patients received OFS while 43 out of 144 (29.9%) patients received OFS after that. No significant difference was found between the proportion of patients receiving OFS before and after the results of SOFT trial came out ( P=0.112) . Age, histological grade, pN status, Ki?67 status, molecular subtype and acceptance of chemotherapy were correlated with OFS treatment (P<0.05). Age, tumor grade and pN were independent significant predictors of OFS usage. Conclusions After the results of joint analysis came out, clinicians began to apply OFS with exemestane to premenopausal women with HR positive breast cancer. There is no significant difference between the proportion of patients receiving OFS before and after SOFT trial. Age, tumor grade and pN status are independent significant predictors of OFS treatment. Patients younger than 40, with histological grade Ⅱ or Ⅲ tumor and with pN1 or pN2 status are prone to receive OFS.

Objective To analyze the applied condition of ovary function suppression ( OFS) before and after joint analysis of TEXT and SOFT trials and SOFT trial, and to identify the relevant factors of OFS usage. Methods The analysis was performed in premenopausal women with hormone receptor ( HR ) positive breast cancer receiving surgical treatment from Apr 2013 to Oct 2015 in Ruijin Hospital, Shanghai Jiaotong University School of Medicine. Adjuvant treatment strategy was made in the multidisciplinary team ( MDT) meetings. We analyzed the applied condition of OFS before and after joint analysis, SOFT trial and its relevant factors. Results Among 454 patients, 114 (25.1%) patients received OFS. Before the results of joint analysis came out, all the patients ( 38/38) received OFS together with tamoxifen ( TAM);after the results came out, clinicians began to put OFS with exemestane into practice, among 76 patients, 41(53.9%) patients received OFS with exemestane while 35 (46.1%) patients received OFS together with TAM. Before the results of SOFT trial came out, 71 out of 310 (22.9%) patients received OFS while 43 out of 144 (29.9%) patients received OFS after that. No significant difference was found between the proportion of patients receiving OFS before and after the results of SOFT trial came out ( P=0.112) . Age, histological grade, pN status, Ki?67 status, molecular subtype and acceptance of chemotherapy were correlated with OFS treatment (P<0.05). Age, tumor grade and pN were independent significant predictors of OFS usage. Conclusions After the results of joint analysis came out, clinicians began to apply OFS with exemestane to premenopausal women with HR positive breast cancer. There is no significant difference between the proportion of patients receiving OFS before and after SOFT trial. Age, tumor grade and pN status are independent significant predictors of OFS treatment. Patients younger than 40, with histological grade Ⅱ or Ⅲ tumor and with pN1 or pN2 status are prone to receive OFS.

Objective To investigate the value of the application of evidence-based medicine combining problem-based learning (EBM-PBL) in hematology internal teaching.Methods All the interns (n=112),who studied in hematology department from Mar.2013 to Feb.2014,were divided into two groups by parallel.One group received the traditional classroom oriented learning model (n=57),the other was trained how to obtain the most effective and correct evidence and autonomous learning (EBM-PBL,n=55).After two weeks learning,the different effectiveness was evaluated by comparing the oral and written tests holding instantly and annual final exam.Further,feedbacks were anonymously collected from the teachers and students in EBM-PBL group.Results The test scores of oral and written test in EBM-PBL are both significantly higher than those in control group (P=0.000),especially the oral exam.Compared with the instant test,the scores in later oral (P=0.054) and written (P=0.023) examinations were slightly decreased in EBM-PBL group,while they both dramatically dropped in control group (P=0.000).The performance of eight-and seven-year students was generally better than those of five-year students,however,five-year students seemed to get more benefits from EBM-PBL teaching.Feedbacks showed that most of the teachers and students agreed that they all made progress from the practice of EBM-PBL teaching.Conclusion It showed that EBM-PBL helps to cultivate students' self updating of medical knowledge and clinical skills,which ensuring them to follow the development in major field.Thereby,they could transform into excellent clinicians from the students.In addition,it also promoted the teachers to renew their knowledge system and the ability of teaching.

Objective To investigate the risk factors for death within 30 days of stroke associated pneumonia(SAP) in elderly patients of the intensive care unit (ICU).Methods Clinical data of 116 patients with SAP who were admitted to ICU were reviewed.The predicting factors of death within 30 days were analyzed through variable analysis method.Results The hospitalization periods of the SAP group and control group were (27±8) d and (12±5) d,the difference was statistically significant(t =1 1.30,P =0.002).The most common pathogenic bacteria in SAP were Klebsiella pneumoniae,Bauman Acinetobacter,Escherichia coli,and gram negative bacteria.There was significant difference between the two groups in term of mortality rate(37.9％(44/ 116) of SAP group,22.0％ (22/100) of control group,x2 =6.423,P =0.011).Logistic regression analysis showed that basic diseases(OR =2.778,95％ CI:1.205-6.401),high CRUB-65 score (OR =1.978,95％ CI:0.871-11.098),lower Glasgow coma score(GCS) (OR=3.601,95％CI:0.244-9.477),bucking(OR=3.020,95％CI:1.305-10.603),mechanical ventilation(OR=2.654,95％CI:1.176-5.990),shock(OR=2.636,95％ CI:1.164-5.969) and high plasma CRP level(OR=2.333,95％CI:1.046-5.206) were risk factors for SAP (all P＜0.05).In Cox regression analysis,a GCS score of ＜ 9 was an independent risk factor for 30 d mortality of patientswithSAP(HR=7.23,95％Cl:2.24-20.11,P=0.001).Conclusion SAP is one of the serious complications of the elderly hospitalized for the acute stroke in the ICU,which may affect the prognosis of the patients.

This paper analyzed international acupuncture and moxibustion literature cited in SCIE of web of science from 1970-2013,using bibliometric methods and visualization analysis tools,according to categories:publication years,countries,organization,authors,subjects and keywords,to explore the topic evolution process and development directions of acupuncture and moxibustion research.

Objective To observe the efficacy and safety of albumin-bound paclitaxel on the patients with advanced malignance in more than the third-lines (including the third-lines).Methods 34 patients with advanced malignance diagnosed by pathological evidence accepted more than the third-lines (including the third-lines) chemotherapy containing albumin-bound paclitaxel after failure of chemotherapy.The efficacy and safety were observed.Results Totally 110 cycles chemotherapy were completed,with a mean of 3.24 cycles in each of the 34 patients.No CR patients,12 cases of PR,9 cases of SD and 13 cases of PD were found.The response rate (RR) was 35.29 ％ (12/34) and the disease control rate (DCR) was 61.76 ％ (21/34).The main toxicity was hematologic toxicity,including neutropenia in 26 cases (76.47 ％),anemia in 14 cases (41.18 ％) and thrombocytopenia in 3 cases (8.82 ％).Other common adverse reactions included alopecia in 27 patients (79.41％) and muscle and joint pain in 15 cases (44.18 ％).Conclusions The albumin-bound paclitaxel is effective and tolerable in patients with advanced malignance in more than the third-lines (include the thirdlines) chemotherapy.