OBJECTIVE To conduct a systematic review concerning the safety of using glucagon-like peptide-1 receptor agonists （GLP-1RA） before gastrointestinal endoscopy. METHODS Chinese and English databases including CNKI， Wanfang Data， VIP， CBM， and PubMed were searched to collect systematic reviews and meta-analyses on the safety of using GLP-1RA before gastrointestinal endoscopy， with a search period from the inception to September 30， 2025. Report quality， methodological quality， risk of bias， and evidence quality were assessed using the PRISMA 2020 statement， AMSTAR 2 scale， ROBIS tool， and GRADE tool， respectively. Corrected covered area （CCA） was used to quantitatively evaluate the degree of outcome overlap， and a comprehensive quality analysis was performed on the quantitative results of systematic reviews/meta-analyses. RESULTS Ten studies were included. All 10 stu dies had some information deficiencies （15.5-19.5 points）， and were at high risk of bias； 9 studies were extremely low methodological quality， while 1 study was low. In terms of evidence quality， among 88 outcome indexes， there was 1 moderate-level index， 28 low-level indexes， and 59 extremely low-level indexes. The CCA values of the incidence of residual gastric contents， aspiration， endoscopy interruption， repeated endoscopy， inadequate bowel preparation and Boston Bowel Preparation Scale scores were 37.30%， 35.00%， 35.00%， 50.00%， 29.60% and 20.00%， respectively. Results of comprehensive quality analysis showed that compared with the control group， the incidence of residual gastric contents， endoscopy interruption and repeated endoscopy were increased significantly in the intervention group， along with a notably prolonged gastric emptying time and a significantly lower score of Boston Bowel Preparation Scale （ P ＜0.05）. However， the study results regarding the effects of GLP-1RA on the incidence of aspiration and inadequate bowel preparation were inconsistent. CONCLUSIONS The use of GLP-1RA before gastrointestinal endoscopy can increase certain safety risks， including residual gastric contents， endoscopy interruption and repeated endoscopy， prolong gastric emptying time， and reduce the quality of bowel preparation. However， the effects on aspiration and inadequate bowel preparation remain controversial. The reports included in systematic reviews/meta-analyses exhibited low quality in reporting， methodology and evidence， with high risk of bias. Therefore， conclusions should be interpreted with caution.

Background The quality of occupational health technical services is directly linked to the protection of workers' health rights and the efficacy of occupational disease prevention and control. However, the industry still faces critical challenges: sporadic instances of institutional non-compliance and persistent irregularities in professional practice continue to undermine overall service performance. Objective To assess the current quality status of occupational health technical services in Zhejiang Province and propose countermeasures for quality improvement, providing a scientific basis for policy optimization and service delivery quality enhancement. Methods A total of 69 occupational health technical service institutions in Zhejiang Province that obtained formal accreditation as of April 30, 2024, were sampled, including 3 public institutions and 66 private institutions (comprising 3 formerly Class-A, 28 formerly Class-B, 11 formerly Class-C, and 24 newly certified institutions). Following the Technical Protocol for Quality Monitoring of Occupational Health Technical Service in Zhejiang Province and the Technical Protocol for Proficiency Testing of Occupational Health Detection in Zhejiang Province, a quality assessment task force comprising national and provincial experts was established. Evaluation was conducted across four dimensions: qualification maintenance and compliance, standardization of technical services, authenticity of technical services, and proficiency testing, utilizing a combination of document review, on-site inspections, and technical skill assessments. Results The occupational health technical service institutions in Zhejiang Province were predominantly private entities (82.5%), with significant disparities in overall service quality. The pass rates for qualification maintenance and compliance, technical service standardization, technical service authenticity, and the excellence rate for laboratory proficiency testing were 81.5%, 80.7%, 97.3%, and 90.4%, respectively. Regarding qualification maintenance, the pass rates for "environmental conditions" (49.8%, 56.7%) and "instrumentation and equipment" (58.2%、65.6%) were significantly lower for formerly Class-C and newly certified institutions compared to other categories. In terms of technical standardization, "standardized on-site inspections" recorded the lowest pass rate (67.4%), with newly certified institutions at only 48.0%. Regarding technical service authenticity, formerly Class-C institutions exhibited issues such as missing raw chromatograms for blank samples (85.7% pass rate). In laboratory proficiency testing, public and formerly Class-A institutions achieved 100% excellence rates, but the performance of formerly Class-C and newly certified institutions was comparatively weak; specifically, the failure rate for organic analysis in formerly Class-C institutions reached 20%; the failure rate for dust testing items in newly certified institutions was 10.3%. Conclusion The overall quality of occupational health technical services in Zhejiang Province still requires significant improvement, particularly in basic institutional conditions, the standardization of on-site inspections, and laboratory proficiency in organic and dust analysis. Formerly Class-C and newly certified institutions should be the primary focus of quality management efforts. Differentiated regulatory strategies are recommended, alongside strengthening interim and ex-post supervision to gradually enhance the quality of occupational health technical services across all institutions.

OBJECTIVE To investigate the effects and underlying mechanism of Huangqi granules on hair growth in mice with seborrheic alopecia based on Toll-like receptor 4 （TLR4）/myeloid differentiation primary response protein 88 （MyD88） signaling pathway. METHODS Male mice were randomly divided into control group， model group， inhibitor group （treated with 0.3 mg/kg TLR4 inhibitor TAK-242）， Huangqi granules group （treated with 1.0 g/kg Huangqi g ranules） and Huangqi granules+activator group （treated with 1.0 g/kg Huangqi granules combined with 2.5 mg/kg TLR4 activator lipopolysaccharide）， with 12 mice in each group. Except for the control group， the seborrheic alopecia model of mice in other groups was induced by applying rosin-paraffin mixture on the back and injecting testosterone propionate subcutaneously. After modeling， mice in each group were given intragastric administration and intraperitoneal injection of corresponding drugs or （and） normal saline once a day for 20 consecutive days. The time of skin color transition and hair emergence time were compared among those groups. After the last medication， the length of newly-grown hair， serum levels of immune factors [interferon-γ （IFN-γ）， interleukin-4 （IL-4） ] and sex hormones [testosterone （T）， dihydrotestosterone （DHT） ] ， as well as the levels of hair growth factors [insulin-like growth factor 1 （IGF-1）， vascular endothelial growth factor （VEGF）， transforming growth factor-β 1 （TGF-β 1 ） ] in the dorsal skin tissue were measured in each group. Pathological changes and cell apoptosis of hair follicle tissue were observed， and the protein expressions of TLR4 and MyD88 in the dorsal skin tissue were detected. RESULTS Compared with the control group， hair follicle cells in the model group were irregular in size， disordered in arrangement， and showed a significant reduction in melanin content. The time of skin color transition， hair emergence time， the levels of IFN-γ， T， DHT and TGF-β 1 ， the apoptosis rate of hair follicle cells， as well as the protein expressions of TLR4 and MyD88 in the model group were significantly prolonged/increased/up-regulated， while the length of newly-grown hair， the number of hair follicles， and the levels of IL-4， IGF-1 and VEGF were significantly shortened/reduced/decreased （ P ＜0.05）. Compared with the model group， the morphological structure of hair follicle tissue in the Huangqi granules group and inhibitor group was significantly restored， and the above quantitative indicators were significantly improved （ P ＜0.05）. Moreover， the effects of the two groups were comparable （ P ＞0.05）. The TLR4 activator could significantly reverse the improvement effect of Huangqi granules on the above indicators in mice with seborrheic alopecia （ P ＜0.05）. CONCLUSIONS Huangqi granules can regulate immune function， reduce hair follicle cell apoptosis， and promote hair growth in mice with seborrheic alopecia， which may be related to the inhibition of TLR4/MyD88 signaling pathway activation.

Objective To develop a precise method for analyzing urinary peptides based on electromembrane extraction(EME)combined with liquid chromatography-tandem mass spectrometry(LC-MS/MS),and to evaluate its potential applicability in tumor biomarker screening.Methods A total of 15 disease-associated peptides were selected as the target analytes.A supported liquid membrane(SLM)composed of n-octanol containing 5%di(2-ethylhexyl)phosphate was employed,with the donor phase being a 1∶1 mixture of urine and 100 mmol/L formic acid and urine,and the acceptor phase being 20 mmol/L formic acid containing 50%dimethyl sulfoxide(DMSO).After EME at 40 V for 15 min,the acceptor phase solution was analyzed by LC-MS/MS.Subsequently,the method,EME combined with LC-MS/MS(EME-LC-MS/MS),was preliminarily validated utilizing urine samples from 12 healthy controls and 7 patients with urinary system tumors.Results All 15 peptides exhibited excellent linearity in the range of 0.1-100.0 ng/mL(r≥0.995),with the limits of detection(LODs)being 0.01-0.50 ng/mL and the limits of quantification(LOQs)being 0.03-1.50 ng/mL.The spiked recoveries ranged from 21.0%to 71.2%,with relative standard deviations(RSDs)of 0.8%-20.0%(n=3).Small-sample analysis of clinical specimens revealed that the concentration of bradykinin 1-5 in the urine were significantly higher in tumor patients(median:0.65 ng/mL)than that in healthy controls(median:0.37 ng/mL)(P<0.05),suggesting its potential as a specific biomarker for urinary system tumors.Conclusion The EME-LC-MS/MS method established in the study features simplicity,high efficiency,and high sensitivity,enabling precise determination of trace-level peptides in urine samples.Moreover,this approach provides a reliable methodological basis for disease biomarker screening and promotes the clinical application of electromembrane extraction.

Objective To analyze the effect of Hsa-circ-0101216 on gemcitabine(GEM)chemotherapy resistance in pancreatic cancer and its mechanism.Methods Differentially expressed circRNAs between GEM-resistant pancreatic cancer cells and parent cells were screened using the GEO database.Pancreatic cancer GEM resistant cell lines(BxPC-3-GEM and Capan-1-GEM)were constructed by intermittent concentration gradient method.qRT-PCR was used to detect the expression of Hsa-circ-0101216 in cells.GEM resistant pancreatic cancer cell lines were taken and divided into sh-circ-0101216 group(knockdown of circ-0101216),sh-NC group(transfected with sh-NC),and blank control group(untreated).CCK-8 assay and EdU proliferation assay were used to detect the half inhibitory concentration(IC50)of GEM and proliferation ability of cells in each group.Western blotting was performed to detect the expression of multidrug resistance-related protein 1(MRP1),breast cancer resistance protein(BCRP),and human equilibrative nucleoside transporter-1(hENT-1).A subcutaneous xenograft tumor model of human pancreatic cancer in nude mice was constructed,and sh-NC+GEM group and sh-circ-0101216+GEM group(n=6)were set up.The volume and weight of xenograft tumor in nude mice were compared between the two groups.Western blotting and immunohistochemistry were used to detect the expression of MRP1,BCRP,and hENT-1 proteins in xenograft tumor tissues,and EDU proliferation assay was used to detect the proliferation ability of tumor cells.Results The GEO database screening showed that Hsa-circ-0101216 was up-regulated in GEM-resistant pancreatic cancer cell lines.Pancreatic cancer GEM-resistant cell lines were successfully constructed,and the expression levels of Hsa-circ-0101216 and the IC50 value in GEM-resistant pancreatic cancer cells BxPC-3-GEM and Capan-1-GEM were significantly higher than those in parental cells(P<0.05).In sh-circ-0101216 group,the IC50 values of GEM,cell viability,EdU positivity rate,and the expression levels of MRP1 and BCRP proteins in GEM-resistant pancreatic cancer cells BxPC-3-GEM and Capan-1-GEM were significantly lower than those in blank control group and sh-NC group,while the expression level of hENT-1 protein was significantly higher(P<0.05 or P<0.001).In sh-circ-0101216+GEM group,the weight and volume of subcutaneous xenograft tumors in nude mice,the expression levels and positive expression rates of MRP1 and BCRP proteins in tumor tissues,and the EdU positive rate were significantly lower than those in sh-NC+GEM group,while the expression level and positive expression rate of hENT-1 protein were significantly higher(P<0.05).Conclusions Hsa-circ-0101216 is highly expressed in GEM-resistant pancreatic cancer cell lines.Its knockdown can inhibit the proliferation of pancreatic cancer cells and enhance the chemosensitivity of pancreatic cancer cells to GEM.The mechanism may be related to the regulation of transmembrane transporter protein expression.

Background: Rhei Radix et Rhizoma has been traditionally used as a potent laxative for centuries due to its remarkable efficacy. Raw pieces of Rhei Radix et Rhizoma (RP) are known for their strong laxative effects, often accompanied by side effects, while steamed Rhei Radix et Rhizoma pieces (SP) possess a milder laxative effect and are widely used clinically. However, there is a lack of comprehensive evidence examining the mechanisms underlying SP's effectiveness, particularly from a bioavailability perspective. Objective: This study aimed to investigate the impact of the steaming process on the in vivo disposition of RP and SP through pharmacokinetics, tissue distribution, and excretion assays. Methods: An ultra-performance liquid chromatography-tandem mass spectrometry method was developed for the simultaneous quantitative analysis of prototype anthraquinones and their glucuronide metabolites. Pharmacokinetic, tissue distribution, and excretion assays were conducted in constipation rats following oral administration of RP and SP. Blood, tissue, urine, and fecal samples were collected and analyzed to compare the absorption, distribution, metabolism, and excretion profiles of anthraquinones, highlighting differences in bioavailability and safety between RP and SP. Results: Compared with the RP group, the SP group showed significantly reduced area under the plasma concentration-time curve, mean residence time, and half-life time values for rhein-8-O-β-D-glucopyranoside, rhein, emodin, aloe-emodin, and their glucuronide metabolites. The clearance values were significantly increased in the SP group. These results demonstrate that SP led to lower exposure levels and higher elimination rates of these components compared with RP. Additionally, these components were primarily distributed in the large intestine, where they exerted their laxative effects. Glucuronide metabolites were mainly excreted through urination, while prototype components were excreted in both urine and feces. Notably, the cumulative excretion of aloe-emodin, emodin, rhein, and their glucuronide metabolites was significantly higher in both urine and feces after SP administration, indicating that SP enhances the excretion of these components compared with RP. Conclusion: The findings suggest that SP reduced anthraquinone exposure levels while enhancing their excretion, demonstrating that the steaming process significantly promotes the elimination of key components. This study provides a comprehensive analysis of how steaming alters the in vivo disposition of Rhei Radix et Rhizoma, offering a scientific basis for the improved safety and clinical use of SP. These insights not only clarify the mechanistic differences between RP and SP but also contribute to a broader understanding of processing-induced modifications in Chinese medicines. This research paves the way for optimizing Chinese medicine processing techniques to enhance the safety and efficacy of herbal therapies.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

How to use family doctors as a starting point to improve the level of chronic disease management is still a ma-jor challenge in China.This study summarizes the current chronic disease management models,family doctor contract service models,and new digital health technologies in China.It expounds the connection between the three and explores the advantages of new digital health technologies in chronic disease management and family doctor contract services,aiming to provide a solid theoretical foundation for improving the level of chronic disease management.

Objective:To compare the ecchymosis of affected limb in the prevention of deep vein thrombosis using low molecular weight heparin sodium and enoxaparin sodium after total knee arthroplasty.Methods:A total of 160 patients (31 males and 129 females) who underwent unilateral knee replacement in Department of Orthopedics of Chengdu Second People's Hospital from Oct. 2020 to Dec. 2023 were included. According to the random number method, all patients were evenly divided into the low molecular weight heparin sodium group (16 males and 64 females) and the enoxaparin sodium group (15 males and 65 females). All patients were treated with low molecular weight heparin sodium or enoxaparin sodium to prevent deep vein thrombosis in the lower limbs after surgery. The ecchymosis area on the affected limb was observed 7 days after surgery, and the incidence and difference in ecchymosis area between the two groups of patients were statistically analyzed. Simultaneously evaluate whether there are differences in hemoglobin, platelet, and coagulation related indicators between the two groups of patients before and after surgery.Results:There were no significant differences in hemoglobin, platelet, and coagulation parameters between the low molecular weight heparin sodium group and the enoxaparin sodium group before and after surgery ( t=1.13, -0.27, -0.47, 0.27, 0.34, -0.27, -0.89, -0.46, P=0.27, 0.34, 0.64, 0.83, 0.74, 0.97, 0.24, 0.65). The incidence of ecchymosis in patients with low molecular weight heparin sodium group and enoxaparin sodium group was 61.25% and 67.50%, respectively, with no statistically significant difference in the incidence of ecchymosis between the two groups ( P=0.41). The average size of ecchymosis in the two groups of patients was (40.40 ± 60.07) cm 2 and (37.41 ± 43.21) cm 2, respectively. And there was no statistically significant difference in ecchymosis area ( P=0.61) . Conclusion:Both patients had limbs’ecchymosis in the process of preventing deep venous thrombosis of lower limbs after total knee replacement. This indicates that the two anticoagulants had a certain effect on postoperative skin ecchymosis of total knee. And the incidence rate and area of ecchymosis of affected limbs were similar in the two groups.

Objective To investigate the current status of job competency of full-time personnel who engaged in gastrointestinal endoscope cleaning and disinfection in medical institutions in Hubei Province,analyze the influencing factors,and provide reference for conducting the training for full-time personnel in gastrointestinal endoscope clea-ning and disinfection.Methods Through expert consultation and revision,as well as forming of questionnaire,an online survey was conducted.The questionnaire was filled out by full-time personnel who engaged in endoscope cleaning and disinfection in the endoscopy centers/rooms in medical institutions.Results A total of 195 full-time personnel engaged in cleaning and disinfecting gastrointestinal endoscopes in 185 medical institutions participated in the survey,with a self-assessment score of(4.48±0.41)point for job competency.Univariate analysis showed that there were statistically significant differences in the self-assessment scores of job competency based on different le-vels of training,training frequency,income satisfaction,and daily diagnosis and treatment volume(all P＜0.05).Multiple linear regression analysis indicated that full-time personnel with working years＞10 years,satisfying with their income,participating in provincial/national level training,receiving training at least once per year,and having an average daily diagnosis and treatment volume＞50 cases had higher self-assessment score of job competency(all P＜0.05).Conclusion In order to enhance the job competency of personnel who engage in gastrointestinal endo-scope cleaning and disinfection,it is recommended to encourage the participation in provincial/national training,and the hospital-wide training should emphasize the application and disposal of cleaning,disinfection,and storage de-vices of gastrointestinal endoscope,as well as disinfection knowledge,and encourage personnel to conduct relevant research.