ObjectiveTo investigate the effects of the combination of components from Tripterygii Radix et Rhizoma and Chuanxiong Rhizoma on rheumatoid arthritis fibroblast-like synoviocytes （RA-FLSs） and the underlying mechanism. MethodsRA-FLSs were grouped as follows： blank control， positive control （methotrexate）， Tripterygii Radix et Rhizoma components， Chuanxiong Rhizoma components， and components from Tripterygii Radix et Rhizoma+Chuanxiong Rhizoma. The cell-counting kit-8 （CCK-8） assay was employed to the cell proliferation， invasion， and apoptosis. The levels of tumor necrosis factor （TNF）-α， interleukin （IL）-6， reactive oxygen species （ROS）， and malondiadehyde （MDA） in cells were measured. Western blot was employed to determine the protein levels of nuclear factor erythroid 2-related factor 2 （Nrf2）， heme oxygenase-1 （HO-1）， nuclear factor-kappa B （NF-κB） p65， phosphorylated inhibitory subunit of NF-κBα （p-IκBα）， cysteinyl aspartate-specific protease-3 （Caspase-3）， and B-cell lymphoma 2 （Bcl-2）. Real-time PCR was employed to determine the mRNA levels of Nrf2， HO-1， and NF-κB p65. ResultsThe cells in the groups of positive control， Tripterygii Radix et Rhizoma components， Chuanxiong Rhizoma components， and components from Tripterygii Radix et Rhizoma+Chuanxiong Rhizoma were treated with 2.50 mg·L^-1 methotrexate， 0.20 mg·L^-1 triptolide + 0.20 mg·L^-1 celastrol， 5.00 mg·L^-1 ferulic acid + 20.00 mg·L^-1 ligustrazine， 0.20 mg·L^-1 triptolide + 0.20 mg·L^-1 celastrol + 5.00 mg·L^-1 ferulic acid + 20.00 mg·L^-1 ligustrazine， respectively. Compared with the blank control group， drug administration reduced the proliferation and invasion and increased the apoptosis of cells （P<0.01）， lowered the levels of TNF-α， IL-6， ROS， and MDA （P<0.01）， up-regulated the mRNA and protein levels of Caspase-3， Nrf2， and HO-1 （P<0.01）， and down-regulated the mRNA and protein levels of Bcl-2， NF-κB p65， and p-IκBα （P<0.01）. Compared with the Tripterygii Radix et Rhizoma components group， the combination of components from Tripterygii Radix et Rhizoma+Chuanxiong Rhizoma inhibited the proliferation and invasion （P<0.05） and promoted the apoptosis of RA-FLSs， up-regulated the mRNA levels of Nrf2 and HO-1 and protein levels of Nrf2 and Caspase-3 （P<0.05）， and down-regulated the protein levels of NF-κB p65 and p-IκBα （P<0.05）. ConclusionThe combination of components from Chuanxiong Rhizoma and Tripterygii Radix et Rhizoma can inhibit the proliferation and invasion and promote the apoptosis of RA-FLSs and alleviate oxidative stress and inflammation by inhibiting the NF-κB signaling pathway， activating the Nrf2/HO-1 pathway， and regulating the expression of Bcl-2/Caspase-3.

The investigator-initiated trials （IIT）， as a widely existing form of clinical research both domestically and internationally， have attracted the attention of governments around the world due to the potential legal risks and issues they may cause， and the trend of legal supervision has gradually strengthened. The legal regulation of IIT in China is still in its early stages， with numerous legal issues that need to be clarified and sorted out. Based on the domestic and international legal reviews of IIT， this paper systematically sorted out the current situation of legal supervision of IIT in China and examined the existing issues， including weak legislative rules， incomplete regulatory systems， imperfect protection rules for research participants and informed consent systems， inadequate regulation of conflicts of interest management， and lax legal supervision of ethical review. Furthermore， this paper proposed suggestions for legal regulation of IIT from three perspectives， including strengthening legislation and emphasizing regulation， improving the mechanism for protecting research participants’ rights and interests， and balancing the legalization of IIT and the scientific development of clinical research， with a view to providing references for legal regulatory paths of IIT in China.

Objective:To investigate the value of nerve conduction velocity testing combined with F-waves, H-reflexes, and sympathetic skin responses in electroneuromyography in the diagnosis of diabetic peripheral neuropathy.Methods:A total of 212 patients with diabetic peripheral neuropathy who received treatment at Fenyang Hospital of Shanxi Province (Fenyang Hospital Affiliated to Shanxi Medical University) from October 2022 to October 2023 were included in this study. These patients were divided into an asymptomatic group ( n = 100) and a symptomatic group ( n = 112) based on the presence or absence of peripheral neuropathy symptoms. Additionally, 100 healthy individuals who underwent physical examinations at the same hospital during this period were included in the control group. Motor nerve conduction velocities were measured for the median nerve, ulnar nerve, tibial nerve, and common peroneal nerve, while sensory nerve conduction velocities were assessed for the median nerve, ulnar nerve, superficial peroneal nerve, and gastrocnemius nerve. F-waves were recorded for the median and tibial nerves. The H-reflexes of the tibial nerve and sympathetic skin response were also evaluated. Differences in motor nerve conduction velocity, sensory nerve conduction velocity, F-waves, H-reflexes, and sympathetic skin responses among the different groups were compared. Results:In the asymptomatic and symptomatic groups, motor conduction velocities were lower ( F = 390.32, 264.63, 228.58, 714.30), distal motor latencies were longer ( F = 316.87, 106.88, 108.58, 217.86), compound muscle action potential amplitudes were lower ( F = 113.38, 59.58, 14.92, 10.36), sensory conduction velocities were slower ( F = 568.87, 532.74, 973.75, 1181.27), sensory nerve action potential amplitudes were lower ( F = 229.53, 309.97, 251.07, 414.82), F-waves were longer ( F = 653.96, 538.20), H-wave latencies were longer ( F = 401.54), and sympathetic skin response latencies were also longer ( F = 147.93, 98.85) compared with those in the control group (all P < 0.05). There were significant differences in motor nerve conduction velocity ( t = 7.33, 13.31), distal motor latency ( t = 13.56, 4.34), compound muscle action potential amplitude ( t = 2.98, 2.99) of the tibial nerve and common peroneal nerve between the asymptomatic and symptomatic groups (all P < 0.05). Significant differences were also observed in the sensory nerve conduction velocity ( t = 12.85, 13.70, 11.08, 15.66) and sensory nerve action potential amplitude ( t = 20.15, 20.26, 8.96, 18.55) of the median nerve, ulnar nerve, gastrocnemius nerve, and superficial peroneal nerve (all P < 0.05). Additionally, differences in F-waves of the median and tibial nerves were significant ( t = 31.96, 13.70, both P < 0.05). The abnormal detection rate of nerve conduction velocity test in the asymptomatic group was 86% (86/100), while the abnormal detection rate of combined nerve conduction velocity test, F-waves, H-reflexes, and sympathetic skin response was 91% (91/100). In the symptomatic group, the abnormal detection rate of nerve conduction velocity test alone was 90.18% (101/112), and the abnormal detection rate of combined nerve conduction velocity test, F-waves, H-reflexes, and sympathetic skin responses was 98.21% (110/112). The abnormal detection rate of combined therapy in the symptomatic group was significantly higher than that in the asymptomatic group ( χ2 = 5.58, P = 0.018). Conclusion:Neuroelectromyography has high diagnostic value for diabetic peripheral neuropathy. The use of F-waves, H-reflexes, and sympathetic skin responses, in conjunction with nerve conduction velocity testing, can enhance the early diagnosis of diabetic peripheral neuropathy in patients who do not exhibit peripheral neuropathy symptoms.

Objective:To establish the perioperative nursing quality evaluation index system for diabetic retinopathy (DR) .Methods:Based on the structure-process-result three-dimensional quality assessment model as the theoretical framework, a preliminary evaluation index system of perioperative nursing quality for DR patients was established through literature analysis and semi-structured interviews. From October to December 2022, experts were selected for two rounds of expert letter consultation, all indicators were screened, modified, and improved, and the evaluation index system of perioperative nursing quality for DR patients was established. The level of expert enthusiasm was expressed by the effective response rate of the questionnaire, the expert authority coefficient expressed the level of expert authority, and Kendall's harmony coefficient expressed the degree of expert opinion coordination.Results:In the first round of expert correspondence, 30 questionnaires were sent out, and 28 valid questionnaires were recovered, with an effective recovery rate of 93.33%. In the second round of expert correspondence, 28 questionnaires were sent out, and 25 valid questionnaires were recovered, with an effective recovery rate of 89.29%. The authority coefficients of the two rounds of expert correspondence were 0.88 and 0.91, and the Kendall's harmony coefficients were 0.202 and 0.212 ( P<0.01). Finally, the perioperative three-dimensional nursing quality evaluation system for DR patients was established, including three primary indexes, seven secondary indexes, and 20 tertiary indexes. Conclusions:The nursing quality evaluation index system for DR patients constructed in this study is scientific and reliable, which can serve as a reference for evaluating the perioperative nursing quality of DR patients and conducting continuous quality improvement work.

Objective:To analyze the status quo of intelligent health management services in health examination institutions in Shanxi Province.Methods:This study is a cross-sectional study. In October 2023, 292 health examination institutions in 11 cities of Shanxi Province were surveyed by convenient sampling with the help of “Questionnaire star” to investigate the health examination (management) institutions to carry out smart health management services from January to December 2022. It was mainly divided into three aspects: pre-inspection, in-inspection and post-inspection, including 6 dimensions, with a total of 21 items. A total of 300 questionnaires were distributed in this survey, and 292 were effectively collected, with an effective recovery rate of 97.33%. The 292 questionnaires were divided and compared according to four regions: the north of Shanxi Province, the middle of Shanxi Province, the south of Shanxi Province and the southeast of Shanxi Province.Results:The health examination (management) institutions were distributed in 11 prefectures and cities in Shanxi Province, and there were 56 (19.2%) tertiary health examination (management) institutions. There were 178 government organizations (61.0%) and 114 social organizations (39.0%). There were 256 (87.7%) that carried out smart health management services; among them, 229 (78.4%) had smart management service systems, and 58 (19.9%) had physical examination centers with smart health management clinics. A total of 108 institutions (36.99%) carried out follow-up visits after intelligent screening. The prevalence of intelligent referrals were 63.3%, 59.6%, 78.0% and 85.2% in the north of Shanxi Province, the middle of Shanxi Province, the south of Shanxi Province and the southeast of Shanxi Province, respectively ( χ2=14.02, P<0.05). The prevalence of self-service in the north of Shanxi Province, the middle of Shanxi Province, the south of Shanxi Province and the southeast of Shanxi Province were 39.2%, 52.3%, 62.0% and 37.0%, respectively ( χ2=9.75, P<0.05). Conclusions:The development of intelligent health management in health examination (management) institutions in Shanxi Province is good, and the service scale continues to grow, but the problem of uneven development among regions is severe. In addition, the proportion of institutions providing services through information technology is not high, and the rate of intelligent management outpatient service, intelligent post-examination follow-up and intelligent physical examination service satisfaction is low.

Objective:To evaluate the relationship between physical activity (PA) and postoperative delirium (POD) in elderly patients undergoing knee or hip arthroplasty.Methods:The study was conducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort, which was a nested case-control study. Medical records from elderly patients undergoing elective knee or hip arthroplasty under spinal-epidural anesthesia at Qingdao Municipal Hospital from August 2022 to August 2023 were collected. The patients were divided into a POD group ( n=89) and a non-POD group ( n=221) based on the occurrence of POD. Peripheral blood samples were collected before surgery, and the cerebrospinal fluid (CSF) 2 ml was extracted after successful puncture under spinal-epidural anesthesia for determination of the concentrations of amyloid-β 42 (Aβ 42), total tau protein (t-tau), and phosphorylated tau protein (p-tau) by enzyme-linked immunosorbent assay. Logistic regression was used to analyze the influencing factors of POD, and the mediation analysis was conducted to examine the mediating role of CSF biomarker in the relationship between PA and POD. Results:Logistic regression analysis showed that the increased concentration of CSF biomarkers Aβ 42 ( OR=0.997, P=0.006), elevated ratio of Aβ 42/t-tau ( OR=0.642, P=0.003), elevated ratio of Aβ 42/p-tau ratio ( OR=0.872, P=0.001) and PA ( OR=0.374, P=0.001) were protective factors for POD, while the elevated concentrations of t-tau ( OR=1.006, P=0.001) and p-tau ( OR=1.030, P=0.011) were risk factors for POD after adjusting for multi-confounders such as hypertension, diabetes, history of drinking, years of education and Mini-Mental State Examination score. The results of the mediation analysis showed that Aβ 42 (20%), t-tau (16%), Aβ 42/t-tau (23%) and Aβ 42/p-tau (28%) played mediating roles in the relationship between PA and POD. Conclusions:PA is a protective factor for POD in elderly patients undergoing knee or hip arthroplasty and CSF biomarkers may play a mediating role in the relationship between PA and POD.

Objective:To evaluate the relationship between the preoperative sleep quality and postoperative delirium (POD) in elderly patients.Methods:Three hundred and eighty-nine patients of either sex, aged 65-90 yr, with American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who underwent elective knee/hip arthroplasty under combined spinal-epidural anesthesia in Qingdao Municipal Hospital from May 2022 to October 2023, were selected. The Pittsburgh Sleep Quality Index scale was applied at 1 day before surgery to assess the sleep quality within 1 month before surgery. The cerebrospinal fluid (CSF) specimens 2 ml were withdrawn from the subarachnoid space before anesthesia for determination of the concentrations of biomarkers (β-amyloid), total tau protein [t-tau], and phosphorylated tau protein [p-tau]) by enzyme-linked immunosorbent assay. Patients were divided into POD group and non-POD group based on whether delirium occurred within 7 days after surgery. Logistic regression was used to identify the risk factors for POD, and the sensitivity analysis was used to test the stability of the regression models. The mediation model was used to examine whether CSF biomarkers mediated the link between sleep quality and POD. The accuracy of preoperative sleep quality and CSF biomarker concentrations in predicting the occurrence of POD was evaluated by plotting the receiver operating characteristic curve and calculating the area under the curve.Results:Two hundred and seventy-nine patients were finally included, with 33 patients in POD group and 246 patients in non-POD group. The results of logistic regression analysis showed that shorter sleep duration, use of hypnotics, daytime dysfunction within 1 month before surgery, elevated t-tau concentrations in CSF, and elevated p-tau concentrations in CSF were risk factors for POD after adjusting for multiple confounding factors such as age, sex, body mass index, years of education, Mini-Mental State Examination score, and VAS score. The results of mediating effect showed that the effect of use of hypnotics and daytime dysfunction within 1 month before surgery on POD was partially mediated by p-tau concentrations in CSF (>10%). The area under the curve of combination of daytime dysfunction, sleep duration, use of hypnotics within 1 month before surgery, and CSF biomarker concentrations in predicting POD was 0.979.Conclusions:Shortened sleep duration, use of hypnotic, and daytime dysfunction with 1 month before surgery are risk factors for POD in elderly patients, and the association between use of hypnotics and daytime dysfunction and POD is partially mediated by p-tau in CSF.

Objective:To explore the influence of pancreatic stents of different lengths on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).Methods:Data of 299 patients with biliary tract diseases who received endoscopic retrograde cholangiopancreatography (ERCP) and 5 Fr prophylactic pancreatic stents placement at the First Affiliated Hospital of Air Force Medical University from January 2013 to January 2022 were retrospectively analyzed. Patients were divided into the short-stent group (<5 cm, n=163) and the long-stent group (>5 cm, n=136). Baseline data, intraoperative procedures, and postoperative outcomes were compared between the two groups and propensity score matching (PSM) was used for complementary analysis. The primary endpoint was the incidence of PEP. The risk factors for PEP in patients with prophylactic pancreatic stents placement was explored by logistic regression analysis . Results:The overall PEP incidence was 11.0% (33/299). There was no significant difference in the PEP incidence [11.7% (19/163) VS 10.3% (14/136), χ 2=0.140, P=0.708], moderate-to-severe PEP incidence [1.8% (3/163) VS 2.2% (3/136), χ 2=0.000, P=1.000], or spontaneous stent dislodgement rate within two weeks [81.7% (103/126) VS 78.4% (87/111), χ 2=0.421, P=0.516] between the two groups. After PSM, 123 patients were included in each group, and the overall PEP incidence was 8.9% (22/246). There was no significant difference in PEP incidence [8.9% (11/123) VS 8.9% (11/123), χ 2=0.000, P=1.000], moderate-to-severe PEP incidence [0.8% (1/123) VS 1.6% (2/123), χ 2=0.000, P=1.000], or spontaneous stent dislodgement rate within two weeks [80.6% (75/93) VS 78.6% (77/98), χ 2=0.126, P=0.722] between the two groups. Logistic regression analysis showed that normal liver function ( OR=2.36, 95% CI:1.01-5.51, P=0.046) and failed bile duct cannulation ( OR=7.51, 95% CI:2.18-25.96, P=0.001) were independent risk factors for PEP in patients with biliary tract diseases who received prophylactic pancreatic stents placement. Conclusion:Longer 5 Fr pancreatic stents (>5 cm) do not further reduce the overall risk of PEP or moderate-to-severe PEP compared with 5Fr-5 cm stent. Normal liver function and failure of bile duct intubation were independent risk factors for PEP after prophylactic pancreatic stent placement in patients with biliary diseases.

Objective:To study the infection and epidemiological characteristics of soil borne nematode disease in Sihong County, Suqian City, and to provide scientific basis for further development of prevention and control measures.Methods:In 2022, according to geographic location, Sihong County was divided into east and west areas. Jieji Town, Shiji Township, and Linhuai Town were selected from the east area, and Tianganghu Township, Meihua Town from the west area. One administrative village was selected as a survey point in each township. Using cluster sampling method, 450 permanent residents aged 3 years old and older in the village were selected as the respondents for questionnaire survey and fecal sample collection. The infection status of hookworms, roundworms, whipworms and pinworms in fecal samples were examined, transparent tape anal swab method for detecting pinworm eggs in children, and influencing factors were analyzed.Results:A total of 2 264 survey subjects were included, 18 cases of soil borne nematodes were detected as positive, with an overall positive rate of 0.80%. Among them, 15 cases were positive for hookworms, 1 case was positive for whipworms, and 2 cases were positive for pinworms, with detection rates of 0.66%, 0.04%, and 0.09%, respectively. No ascaris lumbricoides were detected. Transparent tape anal swab method was used to examine 142 children, and the positivity rate of 1.41% (2/142). By township, the detection rate of soil borne nematodes was the highest in Jieji Town, at 2.41% (11/457); the others were Meihua Town, Tianganghu Township, Shiji Township, and Linhuai Town, with detection rates of 0.89% (4/451),0.66% (3/454), 0 (0/451) and 0 (0/451), respectively. There was a statistically significant difference between different townships (χ 2 = 19.21, P < 0.001). Among the 18 positive cases of soil borne nematode, 7 were males and 11 were females, with detection rates of 0.66% (7/1 063) and 0.92% (11/1 201), respectively, the difference was not statistically significant (χ 2 = 0.47, P = 0.491). The age distribution showed the highest detection rate in the 40 - < 60 age group, at 1.42% (9/634), with statistically significant differences between different age groups (χ 2 = 6.41, P = 0.033). The occupational distribution showed the highest detection rate in farmers, at 1.46% (9/617), with statistically significant differences between different professions (χ 2 = 8.00, P = 0.034). The differences in total soil borne nematode and hookworm detection rates were statistically significant among different methods of treating human and animal feces (χ 2 = 11.01, 9.02, P = 0.003, 0.011). Conclusions:The main species of soil borne nematode infections in Sihong County, Suqian City are hookworms, with fewer infections of whipworms and pinworms, and no roundworm infections observed. There are regional differences in detection rate. In the future, it is necessary to strengthen health education for key populations, enhance health knowledge publicity, and effectively intervene to change unhealthy production and lifestyle, further reducing the infection of soil borne nematodes in Suqian City.

Objective To observe and analyze the application of project achievement style quality control circle in constructing an outpatient intelligent pharmacy pre-job training model,and provide new ideas and systematic solutions for pre-job training of new pharmacists in intelligent pharmacies.Methods 70 pharmacists who were newly employed in outpatient pharmacy of Yantai Yuhuangding Hospital from January 2023 to March 2024 and had no working experience in this position were selected and divided into two groups(the control group and the experimental group)by random draw method.The control group implemented the traditional training mode,and the experimental group adopted the new mode of pre-job training of outpatient intelligent pharmacy constructed by project achievement style quality control circle.The theoretical,skill,and practical examination results at the end of the training period and the satisfaction with training of the newly-appointed pharmacists were collected.Results The assessment scores of theory,skills and practice,and the results of satisfaction with the training of newly recruited pharmacists in the experimental group were significantly higher than those of the control group(P＜0.05).Conclusion The new model of pre-job training for new pharmacists in the outpatient intelligent pharmacy has great advantages in the design of the training program,standardization of the training content,reasonable arrangement of the training cycle,and innovation of the training mode,which improves the pharmacists'satisfaction with the training and achieves good training results.