ObjectiveTo analyze the adverse reactions associated with the clinical use of Banxia （Rhizoma Pinelliae）- Wutou （Aconitum） in the same formula， with the aim of providing a reference for the safety of their clinical application. MethodsLiterature on the clinical application of antagonistic herbs "Banxia-Wutou" used in the same formula， published from January 1st， 2014， to June 30th， 2023， was retrieved from databases including CNKI， VIP， Wanfang， SinoMed， PubMed， Cochrane Library， and Embase. A database was established， and information related to adverse reactions was extracted， including descriptions， classifications， specific manifestations， management and outcomes， patients' primary diseases （western medicine diseases and traditional Chinese medicine diagnoses and syndromes）， and medication information （dosage， ratio， administration routes， and dosage forms）. ResultsA total of 79 researches simultaneously used antagonistic herbs Banxia-Wutou in the same formula and reported associated advers reactions. Gastrointestinal adverse reactions were the most common， with 8 studies reporting management of adverse reactions and 3 studies reporting improvement with no intervention. Among the 11 researches， the adverse reaction relieved to extant， while other 69 researches didn't report the managment of adverse reaction and its prognosis. For the primary disease in western medicine system， chronic bronchitis and chronic obstructive pulmonary disease （COPD） were most common， while gastric pain was the most common symptom in traditional Chinese medicine with spleen and kidney deficiency and spleen stomach cold deficiency being the most frequent syndromes. The most common Banxia dosage was 10 g， while for the Wutou， Fuzi （Radix Aconiti Lateralis Praeparata） was predominant with the highest dose at 15 g. The most frequent herbal combination was Banxia-fuzi， with a 1∶1 ratio. The main administration route was oral， and the primary dosage form was decoction. ConclusionGastrointestinal adverse reactions are the most common in the clinical use of Banxia-Wutou antagonistic herb combinations. Research on the safety of "Banxia-Wutou" combinations should focus on respiratory system diseases and spleen-stomach related conditions.

To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development.

Objective: To investigate the incidence trend and epidemic characteristics of notifiable infectious diseases in Nanjing City from 2004 to 2022, so as to provide the basis for improving the prevention, control, and monitoring strategies of infectious diseases. Methods: Data pertaining to notifiable infectious diseases reported in Nanjing City from 2004 to 2022 were retrieved from the Infectious Disease Surveillance System of Chinese Disease Prevention and Control Information System. Infectious diseases were classified by law and transmission routes. Temporal distribution incidence of notifiable infectious diseases were descriptively analyzed. The trends in incidence of notifiable disease were analyzed using annual percent change (APC) and average annual percent change (AAPC). Results: A total of 33 types of notifiable infectious diseases with 505 275 cases were reported in Nanjing City from 2004 to 2022. The average annual reported incidence was 347.45/105, showing a decreasing trend from 2018 to 2022 (APC=-13.499%, P<0.05), and there was no significant trend overall (AAPC=-1.586%, P>0.05). A total of 203 235 cases of 25 types of class A and B notifiable infectious diseases were reported, with an average annual reported incidence of 139.75/100 000, showing an overall decreasing trend (AAPC=-4.954%, P<0.05). Eight types of class C notifiable infectious diseases with 302 042 cases were reported, with an average annual reported incidence of 207.69/100 000. The reported incidence showed an increasing trend from 2004 to 2018 (APC=10.117%, P<0.05), and a decreasing trend from 2018 to 2022 (APC=-27.467%, P<0.05). There was no trend overall (AAPC=-0.360%, P>0.05). The reported incidence of blood-borne and sexually transmitted infectious diseases was the highest in class A and B infectious diseases, with an average annual reported incidence of 69.88/100 000, which was at a high epidemic level throughout the year, except February. The reported incidence of respiratory infectious diseases was 51.30/100 000, with a high reported incidence in April and December. The reported incidence of intestinal infectious diseases was the highest (178.06/100 000) in class C infectious diseases, with a high reported incidence in June and November. Conclusions The reported incidence of notifiable infectious diseases in Nanjing City was generally stable from 2004 to 2022. The peak incidence of respiratory infectious diseases occurred in winter and spring, and that of intestinal infectious diseases was in summer and autumn. It is necessary to strengthen the surveillance and intervention of blood-borne and sexually transmitted infectious diseases, respiratory infectious diseases, and intestinal infectious diseases to reduce the risk of infectious diseases.

Objective: To evaluate the immunogenicity and safety of co-administration with bivalent human papillomavirus (HPV) vaccine and hepatitis E virus (HEV) vaccine, so as to provide reference for optimizing the vaccination schedule. Methods: Females aged 18 to 25 years were recruited from September to October 2021 in Hengdian College of Film & Television in Zhejiang Province and randomly divided into the HPV+HEV group, the HPV group, and the HEV group. The vaccination procedures were one dose each at 0, 1, and 6 months. Immunogenicity was evaluated by detecting the geometric mean titers (GMT) of HPV16 IgG, HPV18 IgG, and/or HEV IgG antibodies before the first vaccination and one month after the full course of immunization, and comparing the difference in seroconversion, and the GMT ratio. The non-inferiority margin was set at a seroconversion difference of ≤5%, and the lower limit of the 95%CI of the GMT ratio was >0.5. Safety was evaluated by collecting conjunctive local reactions/events and systemic reactions/events within 7 days after each dose, non-conjunctive adverse events within 30 days after each dose, and serious adverse events throughout the observation period (0 to 7 months). Results: A total of 240 females were included, among whom 236 completed the full vaccination program, including 79 in the HPV+HEV group, 77 in the HPV group, and 80 in the HEV group. One month after the full course of immunization, the seroconversion rates of HPV16 IgG and HPV18 IgG antibodies in both the HPV+HEV group and the HPV group were 100%, and the differences in seroconversion rates were 0 (95%CI: -3.39%-+∞). The seroconversion rates of HEV IgG antibodies in both the HPV+HEV group and the HEV group were 100%, and the difference in seroconversion rates was 0 (95%CI: -3.27%-+∞). The GMT of HPV16 IgG and HPV18 IgG antibodies in the HPV+HEV group was 393.88 and 284.86 IU/mL respectively, which was not inferior to 489.39 and 341.24 IU/mL in the HPV group, and the GMT ratios were 0.80 (95%CI: 0.66-+∞) and 0.83 (95%CI: 0.68-+∞), respectively. The GMT of HEV IgG in the HPV+HEV group was 13.55 U/mL, which was not inferior to 12.72 U/mL in the HEV group, and the GMT ratio was 1.07 (95%CI: 0.92-+∞). The incidences of pain, pruritus, and induration in the HPV+HEV group were 54.43%, 21.52% and 40.51% respectively, which were significantly higher than 10.39%, 0, and 0 in the HPV group (all P<0.05). The incidences of redness/swelling, muscle pain/general weakness in the HPV+HEV group were 2.53% and 0, respectively, which were significantly lower than 12.50% and 16.25% in the HEV group (both P<0.05). Conclusion The co-administration of the bivalent HPV vaccine and HEV vaccine is not inferior to individual vaccination in terms of immunogenicity and safety, and the vaccination plan can be optimized through co-administration.

Objective:To explore the oral health behavior cognition and care experience of the primary caregivers for children with ectodermal dysplasia.Methods:From February to April 2023, purposive sampling was used to select 10 primary caregivers of children with ectodermal dysplasia who visited the Department of Dental Implantation of the Affiliated Stomatological Hospital of Nanjing Medical University as the research subject. Semi-structured interviews were used to collect data, and Colaizzi 7-step analysis method was used to sort out and analyze the data.Results:The oral health behavior cognition of the primary caregivers for children with ectodermal dysplasia were summarized into three themes, including incomplete oral health behavior cognition, insufficient emphasis on continuity of health education, and high expectations for disease treatment effectiveness. The care experience was summarized into three themes, namely insufficient family and social support, excessive psychological pressure, and feeling confused and unable to cope with the education and guidance of the child.Conclusions:There are many misconceptions among the primary caregivers of children with ectodermal dysplasia regarding oral health behaviors, including insufficient cognition, high psychological pressure, and numerous care issues. We should strengthen the knowledge training of caregivers through various means, increase their cognitive level, attach importance to their psychological guidance, enhance their emotional response ability, reduce the burden of care and improve their care experience.

Objective To construct a perioperative exercise program for older frail patients with colorectal cancer,and to verify its effect.Methods Based on Goal-directed Theory and literature review,expert consultation was carried out to establish the perioperative exercise program for older frail patients with colorectal cancer.Then,from July to December 2022,the perioperative exercise program was established for older frail patients with colorectal cancer hospitalized in the General Surgery Department of a tertiary A hospital in Suzhou by convenience sampling method for preliminary application.It was divided in to the intervention group and the control group by the ward.The intervention group was applied with the constructed perioperative exercise program on the basis of routine perioperative nursing.The safety,feasibility and intervention effect of the program were evaluated.Results 15 experts were included for 2 rounds of expert consultations.The authority coefficient was 0.880;the coefficient of variation was＜0.250;the Kendall concordance coefficient was 0.167 and 0.224,respectively.The final program contained 4 stages:preoperative exercise,postoperative bed rest,sitting and standing exercise.In the end,54 specific interventions were constructed.During the preliminary application,all the patients completed the program.Generalized estimation equation showed that,on the interaction effect,there was no statistical difference(P=0.752);there were significant differences on the intervention effect and the time effect(P＜0.05).At discharge,there were significant differences in timed up and go test and Barthel Index between the 2 groups(P＜0.05).Only 2 patients experienced mild pain in the intervention group,and no other adverse events occurred.Conclusion The perioperative exercise program for older frail patients with colorectal cancer,based on Goal-directed Theory,is scientific,reliable and safe.It has been preliminarily verified in improving postoperative physical function,activities of daily living and early postoperative recovery of elderly frail patients with colorectal cancer.

Objective:This study aimed to explore the clinical value of myostatin(MST) and follistatin(FST) as biological biomarkers in evaluating sarcopenia in elderly women.Methods:This was a retrospective cross-sectional study that enrolled 350 females aged 20-89 years who underwent physical examinations in Shanghai Huadong Hospital in 2021. Demographic characteristics, muscle mass, fat mass, bone mineral density, hand grip strength, gait speed, and serum indices of MST and FST were collected.Results:The serum levels of MST did not change significantly with age. However, the serum levels of FST increased with age. In women aged≥60 years, MST was positively correlated with total lean mass and appendicular skeletal muscle index(ASMI; r=0.236, P=0.041; r=0.289, P=0.014), while FST was negatively correlated with ASMI( r=-0.265, P=0.030). In multivariate stepwise regression analysis, after adjusting for age, body mass index, hip bone mineral density, and total fat mass, only FST was independently correlated with ASMI( β=-0.238, P=0.006), while MST was not correlated with ASMI. The receiver operating characteristic curve was plotted using muscle mass reduction as the state variable and serum FST level as the test variable. The area under the curve was 0.753. And when the FST cutoff value was 17.49 ng/mL, the maximum Jordan index was 0.46, with a sensitivity of 77.3% and a specificity of 68.7%. Women aged ≥60 years were divided into three groups based on serum FST levels. Compared to the upper third of the serum FST level group, the low third of the FST level group had a significantly reduced risk of suffering from sarcopenia( OR=0.098, P =0.036). Conclusions:Serum FST lever has a better correlation with muscle mass among elderly women, making it a promising biomarker for evaluating muscle mass.

Objective:To explore chromosomal copy number variations (CNVs) and pregnancy outcomes in fetuses with mild to moderate isolated ventriculomegaly (IVM), but without other indications for invasive prenatal diagnosis.Methods:A retrospective analysis was conducted on clinical data of 215 singleton pregnancies with mild to moderate IVM (lateral ventricular width≥10-<15 mm) who underwent chromosomal microarray analysis (CMA), not indicated by advanced age, high risk in serum screening or abnormal history of pregnancy, at the Fujian Maternity and Child Health Hospital between June 2016 and March 2023. The 215 fetuses were grouped into mild ( n=167) and moderate ( n=48) IVM;unilateral ( n=142) and bilateral ( n=73) IVM; first diagnosis of IVM before 28 weeks ( n=138) and thereafter ( n=77). Anomalies other than IVM were excluded via three-dimensional color Doppler ultrasound examination between 22 and 26 weeks of gestation. Out of these cases, 129 were confirmed by fetal cranial MRI, 191 underwent chromosomal karyotype analysis, and 202 cases received cytomegalovirus DNA quantification test for amniotic fluid. The detection rates of pathogenic CNVs in various groups were compared using Fisher's exact test. Results:Among the 215 fetuses, 11 cases (5.1%) of chromosomal abnormalities were detected through CMA, including one trisomy 21, five pathogenic CNVs, and five CNVs of uncertain clinical significance. Within the pathogenic CNVs, there were two de novo mutations with 16p11.2 microdeletion and one de novo mutation with 16p11.2 microduplication, while one 16p11.2 microduplication and one Xp22.31 microdeletion were inherited maternally. Of the CNVs of uncertain significance, there were two 16p13.11 microduplications, each inherited from a different parent, one paternally and one maternally; meanwhile, family validation was refused in the other three cases with 3p22.1 microdeletion, 3p26.3 microdeletion, and 9q21.33q22.31 microduplication. The detection rate of pathogenic CNVs in the moderate IVM group was higher than that in the mild IVM group [6.3% (3/48) vs. 1.2% (2/167)], but the difference was not statistically significant ( P=0.083). Similarly, no significant difference was found in the detection rate of pathogenic CNVs when comparing the unilateral IVM group [2.1% (3/142)] with the bilateral IVM group [2.7% (2/73)], nor between the group diagnosed with VM before 28 weeks gestation [2.2% (3/138)] and that diagnosed ≥28 weeks [2.6% (2/77)] (both P>0.05). After the exclusion of fetuses with chromosomal pathogenic abnormalities ( n=11), cytomegalovirus infection( n=1), and additional ultrasound anomalies ( n=7), and several cases with missing data intrauterine outcomes were followed up in 169 IVM fetuses, including 104 (61.5%) improved, 60 (35.5%) unchanged, and five (3.0%) progressed. Follow-ups were successful for 194 women, of which eight pregnancies were terminated (including one trisomy 21, four pathogenic CNVs, one fetal cytomegalovirus infection, and two progressed to severe IVM). Among the 186 newborns, one was diagnosed with X-linked ichthyosis, and one child who progressed to severe IVM before born was followed until 20 months of age without notable phenotypic abnormalities. The rest 184 babies, including those with CNVs of uncertain clinical significance, exhibited no developmental abnormalities during follow-up between the ages of three months and six years. Conclusions:For those fetuses with isolated mild to moderate IVM, but without indications for prenatal diagnosis such as advanced maternal age, high risk in serum screening or abnormal history of pregnancy, remain having the risk for chromosomal aberrations, and 16p11.2 microdeletion/microduplication might be a frequent CNV associated with this condition. Aside from those with pathogenic chromosomal aberrations, fetal cytomegalovirus infection, or progressive enlargement of the lateral ventricles, most fetuses with isolated mild to moderate IVM have a good prognosis.

Objective:To analyze the distribution and drug resistance of the pathogen of bloodstream infections in patients with malignancies in Shanxi Province Cancer Hospital.Methods:A retrospective case series study was conducted. A total of 8 654 patients with malignancies whose blood culture was detected in Shanxi Province Cancer Hospital between January 2019 and December 2021 were collected, and venous blood was drawn for blood culture. WHONET 5.6 software and SPSS 23.0 software were used to analyze the distribution and drug resistance of the pathogen of bloodstream infections.Results:A total of 600 (6.9%) pathogens were isolated, including 413 (68.8%) strains of Gram-negative bacteria, 168 (28.0%) strains of Gram-positive bacteria, 19 (3.2%) strains of fungi. The top 5 gram-negative bacteria were Escherichia coli (37.7%), Klebsiella pneumoniae (14.2%), Enterobacter cloacae (4.5%), Pseudomonas aeruginosa (3.0%), and Acinetobacter baumannii (2.5%). The top 5 gram-positive bacteria were Staphylococcus aureus (4.2%), Enterococcus faecium (4.0%), Staphylococcus hominis (3.8%), Staphylococcus epidermidis (3.5%) and Streptococcus (3.0%); except Klebsiella pneumoniae, there were no statistically significant differences in the composition ratio of other major pathogens from 2019 to 2021 (all P > 0.05). The resistance rates of Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae to ampicillin were 94.7% (214/226), 100.0% (85/85) and 96.3% (26/27); the resistance rates of those to ciprofloxacin were 61.9% (140/226), 17.6% (15/85) and 7.4% (2/27); and the resistance rates of those to cefoperazone were 62.4% (141/226), 30.6% (26/85) and 25.9% (7/27), respectively. The resistance rates of P. aeruginosa and Acinetobacter baumannii to carbapenems were 5.5% (1/18) and 93.3% (14/15). Staphylococcus aureus, Staphylococcus hominis, Staphylococcus epidermidis were predominantly Staphylococcus. Enterococcus faecium and Enterococcus faecalis were the main types of enterococcus. Positive blood culture samples were mainly distributed in hematology department and intensive care unit. Non-Hodgkin lymphoma (39 strains) and acute myeloid leukemia (12 strains) were the main diseases. Conclusions:The main pathogen of bloodstream infection in patients with malignancies in this area is Gram-negative bacteria, and drug resistance is common. Hospitals should rationally use antibiotics by combining with drug sensitivity test.

Objective To observe the effect and prognosis of recombinant human granulocyte colony-stimulating factor(rhG-CSF)in end-stage liver disease(ESLD)with sepsis.Methods Ninety patients with ESLD complicated with sepsis from January 2022 to December 2023 were selected and randomly divided into rhG-CSF group,thymosin group and control group,with 30 cases each.Compare the liver function,cytokine levels,treatment efficacy,complications,and ESLD model(MELD)scoring system before and after treatment among three groups.Results The total effective rate of rhG-CSF group was 96.67％,which was significantly higher than the other two groups,and the difference was statistically significant(P＜0.05).After treatment,the liver function,cytokine levels,and immune function recovery of the rhG-CSF group and thymosin group were better than that of control group,with statistical significance(P＜0.05).After 12 weeks of treatment and follow-up,the least complications and the lowest mortality rate in the rhG-CSF group.Conclusion The clinical efficacy of rhG-CSF as an adjuvant therapy for ESLD complicated with sepsis is excellent,which can enhance anti-infection ability and improve prognosis.