OBJECTIVE To investigate the effects of Codonopsis pilosula polysaccharide （CPP） regulating the nuclear factor- erythroid 2-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway on gastric mucosal injury in rats with chronic atrophic gastritis （CAG）. METHODS Rats were randomly divided into control group， model group， CPP low-dose， medium-dose and high-dose groups （CPP 10， 20， 40 mg/kg）， and ML385 group （Nrf2 inhibitor ML385 30 mg/kg+CPP 40 mg/kg）， 10 rats per group. CAG rat model was established using N-methyl-N′- nitro-N-nitrosoguanidine combined with irregular diet， then they were given drugs for consecutive 6 weeks. HE staining was used to observe the pathological changes in gastric tissue morphology； the levels of serum gastrin （GAS）， motilin （MTL）， pepsin （PP）， as well as tumor necrosis factor-α （TNF-α）， interleukin-8 （IL-8） malondialdehyde （MDA） and superoxide dismutase （SOD） in gastric mucosal tissue were detected； TUNEL assay was used to observe gastric mucosal tissue cell apoptosis； immunohistochemical assay was adopted to observe the expressions of Nrf2 and recombinant Bcl2 associated X protein （Bax） in gastric mucosal tissue； Western blot was used to detect the expressions of Nrf2， HO-1， Bax and Bcl-2 proteins in gastric mucosal tissue. RESULTS Compared with the control group， the gastric mucosal tissue was damaged； the levels of GAS， MTL， PP and SOD， and the protein expressions of Nrf2， HO-1 and Bcl-2 were significantly reduced in model group （P＜0.05）， while the levels of MDA， TNF-α and IL-8， the cell apoptosis index， and the protein expression of Bax were significantly increased （P＜0.05）. Compared with model group， CPP low-dose， medium-dose and high- dose groups showed varying degrees of improvement in gastric mucosal histopathology； the levels of the quantitative indicators were significantly reversed （P＜0.05）. Nrf2 inhibitor ML385 significantly attenuated the improvement effect of high-dose CPP on the above indicators in CAG rats （P＜0.05）. CONCLUSIONS CPP can improve gastric mucosal injury in CAG rats， and inhibit oxidative stress， inflammatory response， and cell apoptosis. The mechanism of action may be related to the activation of Nrf2/HO-1 signaling pathway.

Objective:To investigate the iodine nutritional status of pregnant women in Hangzhou City and analyze its influencing factors, in order to provide a basis for guiding pregnant women in Hangzhou City to supplement iodine scientifically.Methods:A stratified random sampling method was used to conduct a questionnaire survey on 1 400 pregnant women in Hangzhou City from March to October 2018. Random urine samples and household salt samples from pregnant women were collected, and the levels of urine iodine and salt iodine were measured using arsenic cerium catalytic spectrophotometry and direct titration, respectively. The iodine nutritional status of pregnant women with different basic characteristics and dietary levels were analyzed and compared (Kruskal-Wallis test), and the main influencing factors affecting the urinary iodine concentration level of pregnant women were identified (the ordinal multiple classification logistic regression analysis).Results:The median urinary iodine of pregnant women was 135.00 μg/L, and the qualified iodized salt consumption rate of pregnant women was 83.36% (1 167/1 400). In terms of basic characteristics, there were statistically significant differences in the distribution level of urine iodine among pregnant women with different pregnancy frequency, delivery frequency, and natural abortion frequency ( P < 0.05). In terms of diet, the frequency of consuming milk, yogurt, meat, and whether pregnant women consumed cabbage and cauliflower showed statistically significant differences in urinary iodine distribution levels ( P < 0.05). Ordinal multiple classification logistic regression analysis showed that the urine iodine levels of pregnant women who were pregnant twice were higher than those who were pregnant ≥3 times ( OR = 1.64, P = 0.003). Pregnant women who never or occasionally consumed yogurt had lower urine iodine levels than or equal to those who consumed 2 bottles of yogurt per day ( OR = 0.53, P = 0.044). Pregnant women who never or occasionally consumed meat and those who consumed meat once a week had higher urinary iodine levels than that who consumed meat ≥2 times per week ( OR = 1.40, 1.47, P < 0.05). Conclusions:The overall iodine nutrition of pregnant women in Hangzhou City is at an deficiency level. Pregnancy experience and dietary level are influencing factors on iodine nutrition of pregnant women. It is necessary to carry out in-depth health education for pregnant women, improve the dietary structure during pregnancy, and improve the abnormal iodine nutrition of pregnant women.

Objective:To analyze the level and influencing factors of nurses′ proactive career behavior, problem-solving coping strategies and organizational identification, and to explore the relationship among them.Methods:This was a cross-sectional survey. A total of 536 nurses from Cangzhou Central Hospital, Luanzhou People′s Hospital, the Second Affiliated Hospital of Xingtai Medical College, People′s Hospital of Qiu County, Hebei Province in November 2023 were selected by convenience sampling method and investigated by general data questionnaire, Proactive Career Behavior Scale, Career Coping Strategies Scale and Organizational Identification Scale. The mediation effect was analyzed by AMOS 24.0 structural equation model.Results:Finally, 495 valid questionnaires were collected. There were 432 females and 63 males, 170 cases aged<31 years old, 256 cases aged 31-40 years old, and 69 cases aged>40 years old. The score of nurses′ proactive career behavior was (51.28 ± 9.86) points, problem-solving coping strategies was (16.25 ± 2.81) points, and organizational identification was (19.00 ± 4.84) points. The results of single factor analysis showed that nurses′ proactive career behavior was affected by age, title, department and salary satisfaction( F values were 2.20-24.44, all P<0.05), problem-solving coping strategies was affected by title, department and salary satisfaction ( F=5.72, 2.75, 21.30, all P<0.01), organizational identification was affected by salary satisfaction ( F=23.22, P<0.01). Problem-solving coping strategies, organizational identification were positively associated with proactive career behavior( r=0.786, 0.722, both P<0.01). Problem-solving coping strategies had a partial mediating effect between organizational identification and proactive career behavior( β=0.432, P<0.01), and the mediating effect accounted for 64.48% of the total effect. Conclusions:There is still room for improvement of nurses′ proactive career behavior, problem-solving strategies, and organizational identification. Nursing managers should pay attention to nurses′ job advantage of different age, title and department, and improve salary satisfaction to stimulate their work potential, and improve their organizational identification, guide them to adopt problem-solving strategies in coping with occupational stress, so as to promote the development of proactive career behavior.

Objective:To investigate the prevalence and related influencing factors of thyroid nodules in different occupational groups in Shijiazhuang City.Methods:Different occupational groups who underwent physical examination at the Second Hospital of Shijiazhuang City from May to December 2015 and had lived there for more than 10 years were selected as the investigation subjects, including workers, farmers, science and technology education personnel, medical and health personnel, civil servants and individual businessmen. Questionnaire survey and thyroid examination were conducted, blood lipid, blood glucose and thyroid hormone levels were tested, and related influencing factors of thyroid nodules were analyzed.Results:A total of 1 440 different occupational subjects were surveyed, and the prevalence of thyroid nodules was 20.35% (293/1 440). The prevalence of thyroid nodules in females (22.59%, 159/704) was significantly higher than that in males (18.21%, 134/736), and the difference was statistically significant (χ 2 = 4.26, P = 0.039). There was a statistically significant difference in the prevalence of thyroid nodules in different age groups (χ 2 = 73.87, P < 0.001), with the highest prevalence in the 70 - 80 age group (43.75%, 21/48). There was a statistically significant difference in the prevalence of thyroid nodules among different occupational groups (χ 2 = 36.56, P < 0.001), with the highest prevalence in individual businessmen (31.84%, 78/245). By univariate analysis, the prevalence of thyroid nodules in people with good economic status [27.45% (42/153) vs 19.48% (248/1 273)], radiation exposure history [26.39% (109/413) vs 17.92% (184/1 027)], and diabetes history [33.71% (30/89) vs 19.47% (263/1 351)] was higher (χ 2 = 5.35, 13.06, 10.45, P < 0.05). Conclusions:The prevalence of thyroid nodules in occupational group in Shijiazhuang City is relatively high, and the prevalence of thyroid nodules in females is significantly higher than that in males. Economic status, radiation exposure history and diabetes history are the main influencing factors.

Objective:To explore the predictive value of serum 25-hydroxyvitamin D [25 (OH) D] and interleukin-6 (IL-6) levels in the development of osteoporosis (OP) in gestational diabetes mellitus (GDM) during early pregnancy.Methods:A total of 178 pregnant women with GDM admitted to Shanxi Provincial Children’s Hospital from Sep. 2018 to May. 2022 were selected as the research subjects and divided into OP group and non-OP group based on bone density. General information of patients was collected, and biochemical indicators related to bone metabolism were measured, including calcium (Ca), β-collagen special sequence ( β-CTX), type 1 procollagen amino-terminal peptide (PINP), n-terminal bone calciuim (N-MID), osteocalcin (OC), and bone alkaline phosphatase (BAP). The levels of 25 (OH) D and IL-6 in the serum of the two groups were measured. The predictive value of 25 (OH) D and IL-6 levels for GDM complicated with OP was analyzed. Results:Compared with the non-OP group (29.95±6.88), the serum 25 (OH) D level was significantly lower in the OP group (20.78±6.02) ( t=5.56, P<0.001), and the IL-6 level was significantly higher in the OP group (75.19±9.15) than in the non-OP group (50.23±10.08) ( t=10.26, P<0.001). There was no significant difference in the levels of Ca, P, β-CTX, PINP, or N-MID between the two groups (all P>0.05). The levels of BAP (13.25±3.12) and OC (6.62±1.24) in the OP group were significantly lower than those in the non-OP group (BAP: 18.23±3.78, t=5.52, P<0.001; OC: 8.75±1.52, t=5.87, P<0.001). Pearson correlation analysis showed a positive correlation between 25 (OH) D level and bone density, BAP, and OC ( r=0.26, 0.21, 0.23, all P<0.05), while IL-6 level showed a negative correlation with bone density, BAP, and OC ( r=-0.39, -0.21, -0.27, all P<0.05). ROC curve analysis showed that serum 25 (OH) D and IL-6 could serve as effective diagnostic markers for GDM complicated with OP (AUC=0.853, P<0.0001; AUC=0.869, P<0.0001) during early pregnancy. Conclusions:The serum 25 (OH) D level is decreased and IL-6 level is increased in GDM patients with OP during early pregnancy. The levels of serum 25 (OH) D and IL-6 have predictive value for the development of GDM complicated with OP during early pregnancy.

Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.

Objective:To compare the clinical effects of minimally invasive vitreous surgery with and without anti-vascular endothelial growth factor (VEGF) drugs for polypoid choroidal vascular disease (PCV) complicated with vitreous hemorrhage.Methods:A cohort study was performed.Thirty-six consecutive cases (36 eyes) with PCV combined with vitreous hemorrhage who underwent 25G minimally invasive vitreous surgery in Xuzhou First People's Hospital from June 2015 to June 2020 were enrolled.According to surgical methods, the patients were divided into pars plana vitrectomy (PPV) group (24 eyes) receiving vitrectomy only and PPV+ anti-VEGF group (12 eyes) receiving vitrectomy first and intravitreal injection of anti-VEGF drugs one week after the operation.All patients were followed up for at least 6 months.The best corrected visual acuity (BCVA) and central retinal thickness (CRT) of the two groups before treatment, 1 month after treatment and at the last follow-up were measured and compared.Postoperative complications such as recurrence of vitreous hemorrhage and macular scar formation were recorded.This study followed the Declaration of Helsinki and was reviewed and approved by the Medical Ethics Committee of Xuzhou First People's Hospital (No.xyyll[2021]014).Written informed consent was obtained from each patient before surgery.Results:Statistically significant differences were found in BCVA between the two groups before and after treatment ( Fgroup=8.552, P=0.006; Ftime=31.775, P<0.001).The BCVA of the two groups at 1 month after operation and at the last follow-up were significantly improved in comparison with before treatment, and the BCVA at the last follow-up was significantly better than that at 1 month after operation (all at P<0.05).One month after operation and at the last follow-up, the BCVA of PPV+ anti-VEGF group was better than that of PPV group, showing statistically significant differences (both at P<0.05).Statistically significant differences were found in CRT between the two groups before and after treatment ( Fgroup=4.797, P=0.041; Ftime=295.764, P<0.001).One month after operation and at the last follow-up, the CRT of both groups was significantly improved in comparison with before treatment, and the CRT was significantly better at the last follow-up than 1 month after operation (both at P<0.05).The postoperative 1-month CRT of PPV+ anti-VEGF treatment group was lower than that of PPV group, with statistically significant difference ( P<0.05).No statistically significant difference was found in CRT between the two groups at the last follow-up ( P>0.05).Elevated intraocular pressure occurred in 2 eyes and rhegmatogenous retinal detachment in 1 eye in PPV group, accounting for 8.33% and 4.17%, respectively.Cataract aggravated in 2 eyes in PPV+ anti-VEGF group.The incidence of vitreous rebleeding in PPV group and PPV+ anti-VEGF group was 16.67%(4/24) and 8.33%(1/12), respectively, with no significant difference ( P=0.646).The incidence of macular scarring in PPV group and PPV+ anti-VEGF group was 4.17%(1/24) and 33.3%(4/12), respectively, showing a statistically significant difference ( P=0.030). Conclusions:Minimally invasive vitreous surgery is a safe and effective way to treat PCV combined with vitreous hemorrhage.It can improve vision, reduce CRT, and the effect is gradually enhanced in the short term.Intravitreal injection of anti-VEGF drugs can enhance the postoperative effect of PPV and present better vision and anatomical structure of retina.

Objective To investigate and predict the molecular targets and mechanism of Huanglian Jiedu Decoction (黄连解毒汤, HLJDD) in the treatment of Corona Virus Disease 2019 (COVID-19) through network pharmacology and molecular docking analysis. Methods The chemical constituents and action targets of HLJDD were retrieved on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), SymMap v2, Encyclopedia of Traditional Chinese Medicine (ETCM), a High-throughput Experiment- and Reference-guided Database of Traditional Chinese Medicine (HERB), and Traditional Chinese Medicine Integrated Database (TCMID). UniProt and GeneCards were used to query the target genes that corresponding to the active compounds, and then a compound-target network was constructed using Cytoscape 3.7.2. Gene Ontology (GO) database was used to annotate GO functions. Kyoto Encyclopedia of Genes and Genomes (KEGG) was used to predict the possible mechanisms of active compounds. The Database for Annotation, Visualization and Integrated Discovery (DAVID) was used to analysis the tissue enrichment. The main active compounds in HLJDD are molecularly docked with their corresponding related targets. Results Seventy-six compounds were screened and 458 corresponding targets in the network were obtained. Gene annotation showed that the targets were involved mainly in 1 953 biological processes. 884 signaling pathways was enriched, involving signaling by interleukins, cytokine signaling in immune system, generic transcription pathway, and RNA polymerase II transcription. The targets mainly distributed in the lung, liver, and placenta, involving a variety of immune cells, such as T cells and B cells. The molecular docking results showed that core compounds such as wogonin, berberine, and baicalein had high affinity with tumor necrosis factor (TNF), insulin (INS), and tumor protein 53 (TP53). Conclusion The active compounds in HLJDD may have a therapeutic effect on COVID-19 through regulating multiple signal pathways by targeting genes such as vascular endothelial growth factor A (VEGFA), INS, interleukin-6 (IL-6), TNF, caspase-3 , TP53, and mitogen-activated protein kinase 3 (MAPK3).

Objective:To learn about the iodine nutritional status of pregnant women in Suqian City, Jiangsu Province, and to provide evidence for scientific supplementation of iodine of pregnant women.Methods:From May 2016 to July 2020, five sampling districts were divided in each county (district) of Suqian City according to the oriation of east, west, south, north and center each year. One township (street) was selected from each district, and 20 pregnant women who lived in the local area for more than half a year were selected from each township (street). The 30 g of household salt samples of pregnant women and 5 ml of urine samples at random once were collected to test the salt iodine and urinary iodine content.Results:A total of 2 483 household salt samples of pregnant women were tested, and the median salt iodine was 23.9 mg/kg; among them, 2 454 were iodized salt, and the coverage rate of iodized salt was 98.8%; the qualified iodized salt was 2 383, the qualified rate of iodized salt was 97.1%, and the consumption rate of qualified iodized salt was 96.0%. There were statistically significant differences in coverage rate of iodized salt, qualified rate of iodized salt and consumption rate of qualified iodized salt between different years (χ 2 = 10.55, 13.23, 11.37, P < 0.05). A total of 2 483 urine samples of pregnant women were tested, and the median urinary iodine was 167.6 μg/L, which was at the appropriate iodine level. However, the median urinary iodine of pregnant women in 2020 was 146.7 μg/L, lower than the WHO/UNICEF/ICCIDD recommendation standard (150 μg/L). The differences of median urinary iodine of pregnant women in different years, pregnancy periods and regions were statistically significant ( H = 26.08, 8.17, 19.87, P < 0.05). Conclusions:The coverage rate of iodized salt, qualified rate of iodized salt and consumption rate of qualified iodized salt in Suqian City , meet the national standard for eliminating iodine deficiency disorders. Iodine nutrition of pregnant women in Suqian City is at an appropriate iodine level, but some pregnant women may have iodine deficiency.

ObjectiveTo determine the trend and influencing factors of HIV subtypes in newly reported HIV/AIDS cases in Dehong Dai and Jingpo Autonomous Prefecture （Dehong Prefecture） from 2017 to 2019. MethodsRNA extraction was conducted among newly reported HIV/AIDS cases in Dehong Prefecture from 2017 to 2019 whose plasma volume was more than 200 μL. The gag， env and pol genes were amplified by using RT-PCR and then sequenced to determine the subtypes. ResultsA total of 3 287 HIV-infected cases were newly reported in Dehong from 2017 to 2019. The HIV gag， env and pol genotypes were determined in 1 813 cases. The major subtypes were subtype C （28.4%，515/1 813）， recombination form BC （22.0%，398/1 813） and CRF_01AE （18.1%，329/1 813）. Furthermore， the proportion of subtype B， subtype C and CRF01_AE decreased over years， whereas 01/BC， CRF07_BC and CRF08_BC increased over years in both Chinese and Burmese patients （χ²=75.212，P<0.001）. There were significant differences in gender， age， marital status， ethnicity， educational level and transmission route among Chinese and Burmese HIV-infected cases with diverse HIV genotypes （all P<0.05）. ConclusionHIV subtypes in Dehong change over time， which demonstrates that the proportion of BC recombinant subtypes and unique recombinant subtypes increased significantly.