ObjectiveThis study aims to investigate the effect of Dictamni Cortex on intestinal barrier damage in rats and its mechanism by untargeted metabolomics and targeted metabolomics for short-chain fatty acids （SCFAs）. MethodsRats were randomly divided into a control group， a high-dose group of Dictamni Cortex （8.1 g·kg^-1）， a medium-dose group （2.7 g·kg^-1）， and a low-dose group （0.9 g·kg^-1）. Except for the control group， the other groups were administered different doses of Dictamni Cortex by gavage for eight consecutive weeks. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in the ileal tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to detect the level of cytokines， including tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and interleukin-1β （IL-1β）， in the ileal tissue of rats. Quantitative real-time fluorescence polymerase chain reaction （Real-time PCR） technology was used to detect the expression level of tight junction proteins， including zonula occludens-1 （ZO-1）， Occludin， and Claudin-1 mRNAs， in the ileal tissue of rats to preliminarily explore the effects of Dictamni Cortex on intestinal damage. The dose with the most significant toxic phenotype was selected to further reveal the effects of Dictamni Cortex on the metabolic profile of ileal tissue in rats by non-targeted metabolomics combined with targeted metabolomics for SCFAs. ResultsCompared with the control group， all doses of Dictamni Cortex induced varying degrees of pathological damage in the ileum， increased TNF-α （P<0.01）， IL-6 （P<0.01）， and IL-1β （P<0.01） levels in the ileal tissue， and decreased the expression level of ZO-1 （P<0.05， P<0.01）， Occludin （P<0.01）， and Claudin-1 （P<0.05） in the ileal tissue， with the high-dose group showing the most significant toxic phenotypes. The damage mechanisms of the high-dose group of Dictamni Cortex on the ileal tissue were further explored by integrating non-targeted metabolomics and targeted metabolomics for SCFAs. The non-targeted metabolomics results showed that 21 differential metabolites were identified in the control group and the high-dose group. Compared with that in the control group， after Dictamni Cortex intervention， the level of 14 metabolites was significantly increased （P<0.05， P<0.01）， and the level of seven metabolites was significantly decreased （P<0.05， P<0.01） in the ileal contents. These metabolites collectively acted on 10 related metabolic pathways， including glycerophospholipids and primary bile acid biosynthesis. The quantitative data of targeted metabolomics for SCFAs showed that Dictamni Cortex intervention disrupted the level of propionic acid， butyric acid， acetic acid， caproic acid， isobutyric acid， isovaleric acid， valeric acid， and isocaproic acid in the ileal contents of rats. Compared with those in the control group， the level of isobutyric acid， isovaleric acid， and valeric acid were significantly increased， while the level of propionic acid， butyric acid， and acetic acid were significantly decreased in the ileal contents of rats after Dictamni Cortex intervention （P<0.05， P<0.01）. ConclusionDictamni Cortex can induce intestinal damage by regulating glycerophospholipid metabolism， primary bile acid biosynthesis， and metabolic pathways for SCFAs.

Objective:To investigate the effectiveness of preeclampsia risk prediction models based on maternal risk factors during the first trimester in a local population.Methods:This was a diagnostic study. Pregnant women who underwent prenatal examination in People′s Hospital of Rizhao from May 2019 to May 2022 and had risk factors for preeclampsia were enrolled at 11-13 +6 weeks gestation, and were divided into preterm preeclampsia group, term preeclampsia group and non-preeclampsia group according to the occurrence and the gestational week. Baseline clinical data were collected. The effectiveness of different models in predicting preeclampsia risk was evaluated using receiver operating characteristic (ROC) curves. Results:Among the 559 pregnant women enrolled, 78(14.0%) had preeclampsia, including 35(6.3%) with preterm preeclampsia (preterm preeclampsia group), 43 (7.7%) with term preeclampsia (term preeclampsia group), and 481 (86.0%) without preeclampsia (non-preeclampsia group).The most effective model for predicting preterm preeclampsia in the first trimester was maternal risk factor+mean arterial pressure (MAP)+serum placental growth factor (PLGF)+uterine artery pulse index (UTPI). The area under ROC curve was 0.805, and the sensitivity was 56.6% with a false-positive rate of 10%; the most effective model for predicting term preeclampsia and preeclampsia was maternal risk factor+MAP+UTPI. The area under ROC curve was 0.777, and the sensitivity was 52.6% and 53.5% with a false-positive rate of 10%.Conclusion:The combined predicting strategy for preterm preeclampsia based on maternal risk factors in the first trimester maybe effective among our population.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective To investigate the levels of plasma bile acids(BA)in patients with primary liver cancer(PLC)or metastatic liver cancer(MLC)and their correlation with clinical indicators,as well as the value of plasma BAs combined with alpha-fetoprotein(AFP)in the diagnosis of PLC.Methods This study was conducted among 75 patients with PLC and 79 patients with MLC who attended Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2020 to September 2021 and had a confirmed diagnosis based on histopathological and imaging findings.Peripheral blood samples were collected from all patients,and serum and plasma were separated.Colorimetry and chromatography were used to measure biochemical parameters;electrochemiluminescence immunoassay was used to measure the levels of tumor markers;liquid chromatography-tandem mass spectrometry was used to measure the content of BA.The t-test was used for comparison of normally distributed continuous data,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data;the Spearman's coefficient was used for correlation analysis;the receiver operating characteristic(ROC)curve was used to evaluate clinical diagnostic efficacy.Results The PLC group had significantly lower levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol,and apolipoprotein B than the MLC group(U=1 598,1 255,909,and 889,all P＜0.05).Compared with the MLC group,the PLC group had a significantly higher level of AFP and a significantly lower level of carcinoembryonic antigen(U=1 873 and 926,both P＜0.05).Compared with the MLC group,the PLC group had significantly higher levels of TBA,CA,CDCA,UDCA,TCA,TCDCA,GCA,GCDCA,TUDCA,and GUDCA and a significantly lower level of DCA(all P＜0.05).In the total population,the levels of TBA,CDCA,GCA,GCDCA,GUDCA,TCA,TCDCA,and TUDCA were significantly positively correlated with the level of AFP(all P＜0.05).In the patients with PLC,the levels of GCA,TCA,TCDCA,and TUDCA were significantly positively correlated with the level of AFP(all P＜0.05).Combined measurement of AFP+TCA+GCA+TCDCA had an area under the ROC curve of 0.822(95%confidence interval:0.746-0.898,P＜0.000 1),suggesting that it had the highest diagnostic efficacy.Conclusion There are significant differences in the levels of plasma BA between the patients with PLC and those with MLC,and the differentially expressed BAs are closely associated with liver function impairment and the increase in AFP.BAs combined with AFP has a better clinical value in the diagnosis of PLC.

OBJECTIVE To investigate the impact of noise exposure in metallurgical manufacturing on hearing.METHODS 245 workers exposed to noise in an enterprise and 51 administrative staff were tested for air conduction hearing threshold of pure tones at 0.5-8 kHz in both ears,and the equivalent sound level of workplace noise was measured for 8 hours.The hearing threshold of workers in different jobs was statistically analyzed.RESULTS The hearing threshold of workers exposed to noise at 0.5-8 kHz was significantly higher than that of administrative staff;hearing loss mainly occurred at 4 kHz and 6 kHz;the hearing threshold was positively correlated with working age and age,and the hearing threshold of workers over 40 years old and with working age of more than 6 years were higher than 40 dB HL at both ears at 4 kHz and 6 kHz.CONCLUSION The hearing loss of 4 kHz and 6 kHz is most obvious in noise-exposed workers,and age,working age,and noise exposure intensity were risk factors for hearing loss.It is necessary to strengthen the control of noise sources,attach importance to protective measures such as earplugs,and reduce noise exposure time.

ObjectiveTo analyze the status of and family-related factors associated with extracurricular screen time (ST) among the primary and middle school students in a district of Shanghai, and to provide a scientific basis for the development of targeted intervention measures. MethodsA total of 819 students and their parents from one primary school and one middle school were selected by stratified cluster sampling method from November to December 2022 in a district of Shanghai. A questionnaire survey was conducted to investigate the total extracurricular ST and entertainment ST during school days, weekends and summer and winter vacation, as well as the underlying family-related factors. Taking daily total extracurricular ST>2 h as excessive extracurricular ST and daily extracurricular entertainment ST>1 h as excessive extracurricular entertainment ST. ResultsAmong the 795 valid questionnaires, the proportions of excessive extracurricular ST during school day, weekend and summer and winter vacation were 10.9%, 42.1% and 51.1%, respectively, and the proportions of excessive extracurricular entertainment ST were 16.2%, 63.0% and 71.3%, respectively. The proportion of excessive extracurricular ST on weekend and summer and winter vacation was higher for middle school students than for primary school students, and the proportion of excessive extracurricular ST was higher for the students whose father’s educational level was high school and below than for those whose father’s educational level was junior college and above (both P<0.05). Multivariate logistic regression analysis after controlling confounding factors showed that the students with poor parent-child relationships (aOR=1.40‒1.96) and parental daily ST>2 h (aOR=1.83‒3.85) were more likely to have an excessive total extracurricular ST and entertainment ST. ConclusionThe proportion of excessive extracurricular ST for the primary and middle school students in Shanghai is relative high during weekend and summer and winter vacation, especially for entertainment purposes. Improving parent-child relationships and reducing parental excessive ST may be important intervention measures.

Objective To investigate the predictive value of nutritional status assessment for postoperative delirium (POD) risk in elderly patients with hip fracture. Methods A total of 114 elderly patients with hip fracture were selected as study subjects. According to the occurrence of POD, they were divided into delirium group (43 cases) and non-delirium group (71 cases). General information, laboratory indicators, geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) scores were collected for the two groups. Multivariate Logistic regression analysis was used to explore the independent influencing factors of POD occurrence. Receiver operating characteristic (ROC) curves were plotted, and the area under the curves (AUC) were calculated to analyze the predictive value of each independent influencing factor for POD risk. Results The proportion of diabetic patients, fasting blood glucose and CONUT scores in the delirium group were higher, but GNRI and PNI were lower than that in the non-delirium group (P < 0.05). Multivariate Logistic regression analysis showed that blood glucose, GNRI, PNI, and CONUT scores were independent influencing factors for POD occurrence (P < 0.05). ROC curve analysis revealed that the AUCs of blood glucose, GNRI, PNI, and CONUT scores alone in predicting POD risk were 0.610, 0.780, 0.821, and 0.749, respectively, which were lower than the AUC (0.897) when the four factors were combined. Conclusion Blood glucose, GNRI, PNI, and CONUT scores are independent influencing factors for POD occurrence in elderly patients with hip fracture. The combined use of these four factors has good predictive value for POD risk.

Objective: To develop an assessment questionnaire for screen based behaviors among primary and secondary school students, so as to provide a basis for comprehensive assessment among the population. Methods: Nineteen experts were invited to take part in this study from August to September 2022. The initial framework and item pool of the assessment questionnaire were developed based on literature review and a series of guidelines and standards issued by the national education and health authorities, as well as relevant domestic and foreign guidelines, and were combined with existing assessment tools that were used to evaluate screen based behavior among these age groups. Experts in related fields were selected for two rounds of Delphi consultation to determine the dimensions, items and corresponding weights of the assessment questionnaire. Results: The response rates from two rounds of consultation were 95.0% and 100.0% respectively, the opinion submission rates were 89.5% and 63.2% respectively, and the authority coefficient ( Cr ) was 0.87. An assessment questionnaire was finally designed, consisting in 44 items and four dimensions, namely screen use type and time, screen use related health behaviors, safety and civilization in screen use, and reasonable arrangement of screen and non screen activities. The coefficient of variation( CV ) of each item ranged from 0.00 to 0.19, and the Kendall s W increased from 0.22 to 0.34( P <0.01). Expert opinions were in agreement and credible. Conclusion The designed assessment questionnaire can be used to comprehensively evaluate screen based behavior among primary and middle school students, and provides a basis for subsequent intervention measures to improve screen based behavior among this population.

Objective:To explore the effect of teach-back method combined with follow-up nursing on the adherence of glucocorticoid medication in patients with uveitis.Methods:From July to December 2021, 243 patients with uveitis admitted to the Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University were selected as the study subject by convenience sampling. A total of 120 patients admitted from July to September 2021 were set as the control group, and 123 patients admitted from October to December 2021 were set as the intervention group. The control group received routine medication guidance and follow-up nursing, while the intervention group received medication guidance and follow-up nursing using the teach-back method. The adherence of two groups of patients to glucocorticoid medication before and three months after intervention were compared.Results:Before intervention, there was no statistically significant difference in medication adherence between the two groups of patients ( Z=-0.382, P=0.702). After intervention, the medication adherence of the intervention group patients was better than that of the control group, with a statistically significant difference ( Z=-8.854, P<0.001) . Conclusions:The combination of teach-back method and follow-up nursing can effectively improve the adherence of patients with uveitis to glucocorticoid medication.

Objective:To investigate the efficacy and safety profile of different doses of magnesium isoglycyrrhizinate in the treatment of chronic liver disease with elevated alanine aminotransferase (ALT).Methods:Computer retrieval of literature was conducted in the CNKI, Wanfang, and PubMed databases from the establishment of the databases until February 2023. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included literature after screening the literature and extracting the data. RevMan 5.4 and Stata 15.0 software were used to analyze the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total effective rate, and incidence of adverse events.Results:Finally, 10 articles were selected, including a total of 1 522 cases. All the included studies were of good quality and at low risk of bias. Meta-analysis results showed that compared with 100 mg/d magnesium isoglycyrrhizinate injection, 200 mg/d magnesium isoglycyrrhizinate injection had significantly reduced patients' ALT [ MD = -30.73, 95% confidence interval ( CI): -52.52 ~ -8.94, Z = 2.76, P = 0.006; I2 = 98%, P < 0.001], AST ( MD = -34.30, 95% CI: -57.78 ~ -10.82, Z = 2.86, P = 0.004; I2 = 99%, P < 0.001) and TBil ( MD = -15.37, 95% CI: -27.66 ~ -3.09), Z = 2.45, P = 0.01; I2 = 98%, P < 0.001) levels. The total effective rate reported in seven articles showed no heterogeneity among the studies ( I2 = 0.0%, P = 0.98). The total effective rate was higher in 200 mg/d magnesium isoglycyrrhizinate injection than that of 100 mg/d magnesium isoglycyrrhizinate injection ( OR = 3.49, 95% CI: 2.05 ~ 5.95, Z = 4.59, P < 0.001), and there was no statistically significant difference in adverse reactions. Conclusion:200 mg/d magnesium isoglycyrrhizinate injection can more rapidly and effectively improve the levels of ALT, AST, and TBil in patients with chronic liver disease, with an increased total effective rate and a good safety profile.