Objective To analyze the correlation between the number of oil chambers,the proportion of phloem at cross-section of Aucklandiae Radix and the contents of costunolide and dehydrocostuslactone,and the correlation between inulin quantity,vessel quantity and polysaccharide content in powder characteristics,so as to explore the scientific basis for Aucklandiae Radix"identifying the quality based on appearance differentiation".Methods The constant values of the microscopic features of oil chambers,inulin and vessels were determined by cross-sectional permanent slice method,chloral hydrate method and counting analysis method,and the contents of costunolide and dehydrocostuslactone as well as polysaccharide content were determined by the high-performance liquid chromatography(HPLC)and the phenol-sulfuric acid method,respectively,and the correlation in the two groups of data was analyzed by statistical methods.Results There was a significantly positive correlation between the number of oil chambers per unit area in the cross-section of Aucklandiae Radix and the number of oil chambers per unit area in the phloem and the contents of costunolide and dehydrocostuslactone;there was a significantly positive correlation between the quantity of inulin in the powder of Aucklandiae Radix and the polysaccharide content;there was no correlation between the quantity of vessels and the polysaccharide content.Conclusion This study initially established a new method and a new technology for quality evaluation of Chinese herbal medicines based on the determination of microscopic characteristic constants of Aucklandiae Radix,which can provide a new technical method for the quality control of Aucklandiae Radix.

Objective:To evaluate the quality of critical patient handover practice between emergency room and intensive care unit (ICU) nurses, and to provide a basis for structured handover process.Methods:From March to July 2023, a total of 223 pairs of nurses in emergency room and ICU (including EICU) of 5 Class 3 Grade A general hospitals in Suzhou were selected as the research objects by using cross-sectional survey method and convenience sampling method. Self-designed general information questionnaire and Patient Handover Practice Quality Scale were used to investigate the included 223 pairs of nurses in emergency room and ICU on the current situation of handover time and quality.Results:A total of 211 pairs of nurses were included, including 286 females (67.8%) and 136 males (32.2%). The average age of emergency department nurses was (27.31 ± 2.17) years old, and ICU nurses was (26.96 ± 3.04) years old. The total scores of the patient handover practice Quality Scale for nurses in the emergency room and ICU were (45.25 ± 6.26) and (43.55 ± 7.19) points respectively, and the scores of the information transmission dimension were (20.47 ± 5.43) and (17.66 ± 3.45) points. The scores of common understanding dimension were (7.59 ± 2.31) and (8.58 ± 2.46) points. The scores of work atmosphere dimension were (7.93 ± 2.11) and (8.39 ± 2.29) points. The scores of handover situation dimension were (5.33 ± 1.30) and (5.70 ± 1.53) points, and the differences were statistically significant ( t values were - 6.35-4.22, all P<0.05). There were statistically significant differences in the scores of handover practice quality between emergency room nurses and ICU nurses according to specialization, education background, working years and job category ( t values were - 4.91-2.56, all P<0.05). Conclusions:Emergency room nurses and ICU nurses have different requirements and expectations for handover procedures, so it is necessary to build a structured handover practice framework and carry out personalized handover practice training, in order to achieve the consistency of handover content and improve the quality of critical patients handover practice.

AIM:To analyze the occurrence and clinical characteristics of adverse drug reactions(ADR)induced by four programmed cell death pro-tein 1(PD-1)inhibitors according to literature re-ports,and to provide reference for clinical safe medication.METHODS:PubMed,CNKI,and Wan-fang,and other databases were searched to collect case reports of adverse reactions caused by four PD-1 inhibitors,including camrelizumab,sintilimab,toripalimab,and tislelizumab.RESULTS:A total of 105 eligible literature reports were retrieved from the databases at home and abroad(as of June 1,2022),including 42 reports on camrelizumab with 47 patients,29 reports on sintilimab with 30 pa-tients,21 reports on toripalimab with 24 patients and 13 reports on tislelizumab with 15 patients.Among them,there were 76 males(65.5％)and 40 females(34.5％),with a gender ratio of 1.9:1.0.The age range was between 29 to 84 years old,and the onset of ADR mainly occurred within 4 months af-ter the first use of PD-1 inhibitors.Immune-related adverse reactions were mainly manifested as skin and its attachment(41 cases,34.5％),endocrine sys-tem(25 cases,21.0％),and cardiovascular system(22 cases,18.5％).Most patients improved after symptomatic and supportive treatment.CONCLU-SION:Immune-related adverse effects(irAEs)may occur at any time during treatment with the four PD-1 inhibitors,among these the skin system is most frequently affected,followed by the cardiovas-cular and endocrine systems.This suggests the im-portance of individualized drug administration and stringent control over indications in clinical prac-tice.Close monitoring throughout immunotherapy is essential to minimize or prevent irAEs,thus en-suring patient safety in medication usage.

Based on the standards of modern Chinese medicinal materials, literature and records of ancient books, this article reviewed the preliminary processing of Aucklandiae Radix and processing of its decoction pieces. There are some problems in the records of the initial processing of Aucklandiae Radix, such as lack of specific parameters, inconsistent processing sequence, unclear removal methods of fibrous roots and soil, inconsistent cutting specifications, drying methods and temperature. Different processing methods of Aucklandiae Radix decoction pieces can lead to differences in the content of their index components. From the initial processing of the producing area to softening, slicing, and then secondary drying, it may increase production costs and time, and lead to the loss of active components. There are more than 20 kinds of processing methods in ancient books, such as stirfrying, baking, simmering, grinding juice and so on. However, only paper simmering, bran stirfrying and Coptidis Rhizoma processing are commonly used at present, and other processing methods have great exploration space. Referring to the research results of freshcut processing of other Chinese materia medica containing volatile components, it is considered that the key to ensure the quality of Chinese materia medica and decoction pieces is to formulate a standardized process flow of freshcut processing of Aucklandiae Radix.

Objective: To provide high-quality clinical evidence of the efficacy of Tibetan medicine Honghua Ruyi (HHRY) pills for endometriosis-associated dysmenorrhea. Methods: This study constitutes a multicenter, randomized, double-blind, placebo-controlled trial encompassing a three-menstrual cycle intervention followed by a three-menstrual cycle follow-up period. A total of 164 eligible females with endometriosis-associated dysmenorrhea were randomly divided into HHRY pills and placebo groups in a 1:1 ratio. The primary outcome included dysmenorrhea symptoms assessed using Visual Analog Scale (VAS) scores and quality of life, whereas the secondary outcome measures included the maximum VAS for non-menstrual pelvic pain, duration of pain episodes (in days), frequency and quantity of the consumption of ibuprofen sustained-release capsules (or other non-steroidal anti-inflammatory drugs), and days off work/study for staff/student due to dysmenorrhea, ovarian cyst, and/or pelvic nodule size. The safety was monitored throughout the treatment period. All the analyses were based on the intention-to-treat principle. For continuous outcomes, simple or multiple linear regressions were used to estimate the differences between the HHRY pills and placebo groups, with categorical data expressed as the number and percentage of occurrences. Differences were compared using the chi-square test or Fisher's exact test. The predefined analysis was adjusted for concomitant treatment, a variable considered to be associated with outcomes but unaffected by treatment allocation. Estimates of treatment effects were reported with 95% confidence intervals. Two-tailed P values ≤ .05 were considered statistically significant. Conclusion Positive results from this trial, upon completion would provide robust evidence for the efficacy and safety of HHRY pills in treating dysmenorrhea in patients with endometriosis.

Objective:To evaluate the Efficacy of bicarbonate Ringer′s solution (BRS) for early fluid resuscitation in patients with septic shock.Methods:In this prospective cohort study, 80 patients of either sex with septic shock, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, who required early fluid resuscitation at the Anesthesiology and Intensive Care Unit of the Second Hospital of Hebei Medical University from April 2021 to April 2023, were included and divided into lactated Ringer′s solution group (LR group, n=40) and bicarbonate Ringer′s solution group (BR group, n=40). After the corresponding crystalloid solution 30 ml/kg was intravenously infused over 3-6 h for resuscitation, vasopressor drugs were used to achieve the goal of resuscitation: central venous pressure 8-12 mmHg, mean arterial pressure≥65 mmHg, urine volume> 0.5 ml·kg -1·h -1, the superior vena cava oxygen saturation≥0.7. Arterial blood gas analysis was performed immediately after the diagnosis of septic shock (before resuscitation), immediately after the end of fluid resuscitation and at 6 h after the diagnosis. The vasoactive-inotropic score was calculated. The plasma syndecan-1 concentration and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine (Cr) concentrations were measured by enzyme-linked immunosorbent assay before resuscitation and at 24 h after resuscitation. The 28-day all-cause mortality was recorded. Results:The pH value and HCO 3- concentration were significantly increased immediately after the end of resuscitation in BR group compared with the baseline before resuscitation ( P<0.05). Compared with LR group, the HCO 3- concentration, normal rate of lactic acid and improvement rate of AST were significantly increased immediately after the end of resuscitation ( P<0.05), and no significant change was found in the other parameters of blood gas analysis, vasoactive-inotropic score, plasma syndecan-1 concentrations, concentrations of ALT, AST and Cr in serum, improvement rate of ALT, improvement rate of Cr, and 28-day all-cause mortality in BR group ( P>0.05). Conclusions:Bicarbonate Ringer′s solution is superior to lactated Ringer′s solution for early fluid resuscitation in the patients with septic shock.

Objective:To evaluate the Efficacy of bicarbonate Ringer′s solution (BRS) for early fluid resuscitation in patients with septic shock.Methods:In this prospective cohort study, 80 patients of either sex with septic shock, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, who required early fluid resuscitation at the Anesthesiology and Intensive Care Unit of the Second Hospital of Hebei Medical University from April 2021 to April 2023, were included and divided into lactated Ringer′s solution group (LR group, n=40) and bicarbonate Ringer′s solution group (BR group, n=40). After the corresponding crystalloid solution 30 ml/kg was intravenously infused over 3-6 h for resuscitation, vasopressor drugs were used to achieve the goal of resuscitation: central venous pressure 8-12 mmHg, mean arterial pressure≥65 mmHg, urine volume> 0.5 ml·kg -1·h -1, the superior vena cava oxygen saturation≥0.7. Arterial blood gas analysis was performed immediately after the diagnosis of septic shock (before resuscitation), immediately after the end of fluid resuscitation and at 6 h after the diagnosis. The vasoactive-inotropic score was calculated. The plasma syndecan-1 concentration and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine (Cr) concentrations were measured by enzyme-linked immunosorbent assay before resuscitation and at 24 h after resuscitation. The 28-day all-cause mortality was recorded. Results:The pH value and HCO 3- concentration were significantly increased immediately after the end of resuscitation in BR group compared with the baseline before resuscitation ( P<0.05). Compared with LR group, the HCO 3- concentration, normal rate of lactic acid and improvement rate of AST were significantly increased immediately after the end of resuscitation ( P<0.05), and no significant change was found in the other parameters of blood gas analysis, vasoactive-inotropic score, plasma syndecan-1 concentrations, concentrations of ALT, AST and Cr in serum, improvement rate of ALT, improvement rate of Cr, and 28-day all-cause mortality in BR group ( P>0.05). Conclusions:Bicarbonate Ringer′s solution is superior to lactated Ringer′s solution for early fluid resuscitation in the patients with septic shock.

【Objective】 To analyze the basic characteristics of whole blood donors from blood stations before and after the outbreak of COVID-19. 【Methods】 After excluding invalid data, data related to the basic characteristics of whole blood donors collected from 26 blood stations in China during 2018 to 2021 were statistically analyzed, including the trend of total whole blood donors, the number of repeated blood donors, the frequency of blood donation, the average age of donors and the recruitment of first-time blood donors. 【Results】 Affected by the epidemic, 8 out of 14 indicators were with large variations, accounting for 57%. The overall growth rate of total whole blood donors during the epidemic was higher than before the epidemic (P<0.05).The number of repeated blood donors has shown an increased trend, with a higher number during the epidemic than before (P<0.05). The frequency of blood donation was lower during the epidemic than before(P<0.05).Average ages of blood donors and female blood donors fluctuated widely during the epidemic, both higher than those before the epidemic(P<0.05).The donation rate of first-time blood donors <25 years old and ≥25 years old varied widely and irregularly during the epidemic (both P<0.05). The percentage of first-time blood donors fluctuated irregularly during the epidemic, with overall percentage lower than that before the epidemic(P<0.05). 【Conclusion】 Whole blood donors from 26 blood stations increased after the outbreak of COVID-19, and some indicators in certain areas showed significant fluctuations during the epidemic.

AIM:To investigate the effect of Tongsai granules(TSG)on epithelial barrier dysfunction in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and the underlying mechanism.METHODS:Twenty-four Sprague-Dawley rats were randomly divided into control group,model group,TSG group,and moxifloxacin(MXF)+salbutamol(STL)group.Rat COPD model was established over 8 weeks.On day 3 of week 9,the rats with COPD were intratracheally administered Klebsiella pneumoniae to establish the AECOPD model.On days 1 to 2 and 4 to 7 in week 9,saline was administered via oral gavage to the rats in control and model groups,and the rats in TSG and MXF+ STL groups were treated daily with TSG and MXF+STL by gavage,respectively.Peak expiratory flow(PEF),histopatho-logical changes,and the expression levels of interleukin-1β(IL-1β),IL-6,tumor necrosis factor-α(TNF-α),matrix me-talloproteinase 2(MMP2),MMP9,zonula occludens-1(ZO-1),E-cadherin(E-Cad)and occludin(OCC)were deter-mined.Moreover,human bronchial epithelial BEAS-2B cells were exposed to cigarette smoke extract(CSE)and treated with different TSG fractions,and the protein levels of ZO-1,E-Cad,OCC,epidermal growth factor receptor(EGFR),phosphorylated EGFR(p-EGFR),extracellular signal-regulated kinase(ERK)and phosphorylated ERK(p-ERK)were determined.RESULTS:Treatment with TSG significantly reduced bronchial wall thickness,mean linear intercept,and the levels of IL-1β,IL-6,TNF-α,MMP2 and MMP9(P＜0.05 or P＜0.01),significantly increased mean alveolar number and PEF(P＜0.01),and up-regulated the ZO-1,E-Cad and OCC protein levels(P＜0.01)in the lungs of AECOPD rats.Treatment with TSG2,the second TSG fraction,increased the protein levels of ZO-1,E-Cad and OCC in a dose-dependent manner in CSE-exposed BEAS-2B cells(P＜0.05 or P＜0.01).Network pharmacology analysis of 328 targets of the com-pounds in TSG2 and 3 864 genes related to AECOPD suggested that TSG2 relieved AECOPD likely through the regulation of ERBB2,ERK,EGFR,IL and WNT signaling pathways.Treatment with TSG2 also inhibited CSE-induced increases in p-EGFR and p-ERK levels in BEAS-2B cells(P＜0.05 or P＜0.01).CONCLUSION:Treatment with TSG could maintain airway epithelial barrier function in AECOPD rats,likely through the inhibition of EGFR/ERK signaling pathway.

Objective To analyze Pseudomonas aeruginosa (PA) infection and drug resistance in the elderly with respiratory tract infection, so as to provide a basis for the control of nosocomial infection and rational use of antibiotics. Methods The samples from elderly inpatients with respiratory tract infection were collected between March 2020 and March 2022. PA infection/colonization were investigated, and the drug resistance of pathogens was determined according to CLSI criteria (2019 version). Results There were 123 strains of PA isolated from the sputum and bronchoscopy lavage fluid of elderly patients with respiratory tract infection. The main departments with positive PA detection were respiratory department, ICU ward and neurology department. The difference of PA detection in different years was not statistically significant (P>0.05). The proportion of nosocomial infection in 2021 was lower than that in 2020 (44.44% vs 63.33%, c2=4.410, P=0.036). The resistance rate of 123 isolated PA strains to piperacillin was >90.00%, and they were resistant to ceftazidime, cefotaxime, cefepime, aztreonam and gentamicin to varying degrees. There was no significant difference in resistance rate of PA to antibiotics in different years (P>0.05). In the 123 strains of pathogens, there were 17 strains (13.82%) of carbapenem-resistant PA, and their resistance to common antibiotics was significantly higher than that of carbapenem-sensitive PA (P<0.05). Conclusion The main pathogen of nosocomial infection is PA, and the proportion of nosocomial infection shows a downward trend. The detection rate of carbapenem-resistant PA is high. In clinical treatment, targeted antibiotics can be applied.