BACKGROUND:Acupoint embedding and floating needle therapy are two methods for the treatment of knee osteoarthritis,but there are few reports on the combined treatment of the two methods. OBJECTIVE:To investigate the therapeutic effect of acupoint embedding combined with floating needle therapy on different stages of knee osteoarthritis using generalized estimating equations. METHODS:A total of 436 patients with knee osteoarthritis admitted to Dongguan Hospital of Traditional Chinese Medicine from February 2019 to February 2023 were selected as the research subjects.All patients were randomly divided into a control group with floating needle therapy(n=218)and an observation group with acupoint embedding method combined with floating needle therapy(n=218).Staging was performed according to the K-L staging method.In the control group,there were 57 cases in stage Ⅰ,62 in stage Ⅱ,49 in phase Ⅲ,and 50 in stage Ⅳ,while in the observation group,there were 48 cases in stage Ⅰ,66 in stage Ⅱ,63 in phase Ⅲ,and 41 in stage Ⅳ.The levels of indexes and clinical efficacy were compared between groups before and after treatment.Generalized estimating equation model was used to analyze the influencing factors of clinical efficacy and the interaction effect of different time points,different methods and different stages on therapeutic efficacy. RESULTS AND CONCLUSION:There was no significant difference in baseline data between the observation group and the control group,as well as between the patients of different stages(P>0.05).After treatment,the cure rate of stage Ⅰ patients was the highest after treatment,and the total improvement rate in the observation group was significantly higher than that in the control group.There were significant differences in the cure rate among different stages in each group(P<0.05).After treatment,all indicators in the two groups were significantly decreased.In the control group,there were significant differences in various indicators of patients at different stages after 4 weeks of treatment(P<0.05).In the observation group,after 2 weeks of treatment,there were significant differences in various indicators of patients at different stages(P<0.05),and all the indexes in the observation were lower than those in the control group after 4 weeks of treatment(P<0.05)and the therapeutic effect in the observation group was better than that in the control group.Generalized estimating equation model analysis showed that trauma history,interleukin-6 level,treatment method,treatment time and K-L stage all significantly affected the clinical efficacy in patients.In the interaction effect analysis,after 2 weeks of treatment,there was a significant difference in the visual analogue scale score between the two groups in stages Ⅲ and Ⅳ(P<0.05).After 4 weeks of treatment,there was a significant difference in the visual analogue scale score between the two groups in stages Ⅱ,Ⅲ,and Ⅳ(P<0.05).To conclude,acupoint embedding combined with floating needle therapy is superior to floating needle therapy alone in the treatment of different stages of knee osteoarthritis.Trauma history,interleukin-6 level,treatment method,treatment time and K-L stage significantly influence the therapeutic effect.

BACKGROUND:Carnosic acid,a bioactive compound found in rosemary,has been shown to reduce inflammation and reactive oxygen species(ROS).However,its mechanism of action in osteoclast differentiation remains unclear. OBJECTIVE:To investigate the effects of carnosic acid on osteoclast activation,ROS production,and mitochondrial function. METHODS:Primary bone marrow-derived macrophages from mice were extracted and cultured in vitro.Different concentrations of carnosic acid(0,10,15,20,25 and 30 μmol/L)were tested for their effects on bone marrow-derived macrophage proliferation and toxicity using the cell counting kit-8 cell viability assay to determine a safe concentration.Bone marrow-derived macrophages were cultured in graded concentrations and induced by receptor activator of nuclear factor-κB ligand for osteoclast differentiation for 5-7 days.The effects of carnosic acid on osteoclast differentiation and function were then observed through tartrate-resistant acid phosphatase staining,F-actin staining,H2DCFDA probe and mitochondrial ROS,and Mito-Tracker fluorescence detection.Western blot and RT-PCR assays were subsequently conducted to examine the effects of carnosic acid on the upstream and downstream proteins of the receptor activator of nuclear factor-κB ligand-induced MAPK signaling pathway. RESULTS AND CONCLUSION:Tartrate-resistant acid phosphatase staining and F-actin staining showed that carnosic acid dose-dependently inhibited in vitro osteoclast differentiation and actin ring formation in the cell cytoskeleton,with the highest inhibitory effect observed in the high concentration group(30 μmol/L).Carnosic acid exhibited the most significant inhibitory effect during the early stages(days 1-3)of osteoclast differentiation compared to other intervention periods.Fluorescence imaging using the H2DCFDA probe,mitochondrial ROS,and Mito-Tracker demonstrated that carnosic acid inhibited cellular and mitochondrial ROS production while reducing mitochondrial membrane potential,thereby influencing mitochondrial function.The results of western blot and RT-PCR revealed that carnosic acid could suppress the expression of NFATc1,CTSK,MMP9,and C-fos proteins associated with osteoclast differentiation,and downregulate the expression of NFATc1,Atp6vod2,ACP5,CTSK,and C-fos genes related to osteoclast differentiation.Furthermore,carnosic acid enhanced the expression of antioxidant enzyme proteins and reduced the generation of ROS during the process of osteoclast differentiation.Overall,carnosic acid exerts its inhibitory effects on osteoclast differentiation by inhibiting the phosphorylation modification of the P38/ERK/JNK protein and activating the MAPK signaling pathway in bone marrow-derived macrophages.

Objective　Exploring the risk factors and degree of influence on treatment regression of patients with etiologically positive pulmonary tuberculosis in Bijie city, so as to provide reference for the precise prevention and treatment of pulmonary tuberculosis epidemic. Methods　The medical records of registration, treatment and management of pulmonary tuberculosis patients in Bijie City with positive etiology from 2017 to 2022 were derived from the Tuberculosis Monitoring Report Information Management System. Statistically significant variables were screened using binary logistic regression. Revealing interdependencies between factors and conditional probabilities by constructing Bayesian network models. 　Results　A total of 21 662 cases of etiologically positive pulmonary tuberculosis were registered in Bijie City from 2017 to 2022, with etiologically positive rate of 48.60% and a successful treatment rate of 89.52%, both of which were on the rise overall (χ2trend=2 618.15, P<0.001; χ2trend=102.84, P<0.001). A multifactorial analysis showed that gender, age, ethnicity, occupation, patient origin, HIV test results, migrating population, and treatment classification were influencing factor for the successful treatment rate (P<0.05). The Bayesian network model showed that age and treatment classification were the direct factors affecting the treatment outcome, while gender, occupation and patient origin were the indirect factors. Conditional probability showed that patients<20 years of age and initial treatment had the highest rate of successful treatment (96.75%), with a 3.25% probability of having an adverse outcome; Patients≥80 years of age who were retreated had the lowest rate of successful treatment (58.70%), with a 41.30% probability of having an adverse outcome. Conducting causal effect speculation, when preventing tuberculosis in older persons aged 60 years and over, and the other patients are newly treated patients, the successful treatment rate increased from 89.50% to 93.10%, with an increase of 3.60%; Nearly 50.00% fewer farmers are without tuberculosis, and the source of the other patients is active detection (health check-ups and proactive screening), with an increase in the successful treatment rate from 89.50% to 91.70%, with a change in the conditional probability value of 2.20%. Conclusions　Consultation and management of male, elderly, re-treatment, farmer, HIV-positive pulmonary tuberculosis patients in Bijie should be strengthened. Meanwhile, causal correlation effect inference using Bayesian networks is important for precise prevention, control and treatment of diseases.

Objective:To investigate the status quo of burnout and influencing factors of burnout of wound therapists in China, so as to provide support for the growth and development of wound therapist.Methods:From September 2022 to March 2023, a total of 235 specialist nurses certified as wound therapists in China were selected as research objects by the convenient sampling method. General information questionnaire of wound therapists, Areas of Worklife Scale (AWS), Specialty Nurse Work Engagement Scale (SNWES) and Maslach Burnout Inventory-Human Service Survey (MBI-HSS) were used to investigate the wound therapists. Binomial Logistic regression analysis was used to explore the influencing factors of wound therapist burnout.Results:A total of 235 questionnaires were sent out in this study, and 219 were effectively collected, with an effective recovery rate of 93.2%. Among 219 wound therapists, 125 (57.1%) were positive for burnout. The results of binomial Logistic regression analysis showed that job title, work load, team atmosphere and work value were the influencing factors of wound therapist burnout ( P<0.05) . Conclusions:The detection rate of occupational burnout among wound therapists is relatively high, and professional titles, workload, team atmosphere and work value affect their job burnout, suggesting that nursing managers should adopt corresponding measures to improve the occupational environment of wound therapists and reduce their job burnout.

Objective:To overview the systematic reviews of prevention and management measures of medication errors, so as to provide evidence support for clinical decision-making for medical staff.Methods:Cochrane Library, Australia Joanna Briggs Institute Evidence-based Healthcare Center database, CINAHL, PubMed, Embase, CNKI, SinoMed, Wanfang database and VIP database were searched by computer to search for systematic reviews of prevention and management measures of medication errors, and the search period was from establishment of the databases to June 30, 2023. Two researchers with systematic evidence-based training applied A Measure Tool to Assess Systematic Reviews 2 (AMSTAR 2) to evaluate the literature quality, and Grades of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the quality of outcome indicators.Results:Finally, a total of 19 systematic reviews were included. The overall quality evaluation using AMSTAR 2 was relatively low, with one article rated as high-quality, one article rated as low-quality and 17 articles rated as extremely low-quality. According to the evidence quality evaluation results of GRADE system for 55 outcome indicators of 19 systematic reviews, 3 pieces of evidence were medium, 27 pieces of evidence were low and 25 pieces of evidence were extremely low, indicating an overall low quality of evidence.Conclusions:The related researches on prevention and management of medication errors have been carried out extensively, and the computer system is one of the effective measures to reduce medication errors. The effectiveness of measures such as administration process modification, doctor/nurse education and training, double check, pharmacist intervention, automated dispensing cabinet/ automated pump and drug display is still unclear and needs to be further confirmed by large sample size and high-quality studies.

Lung cancer ranks the top of malignancies that cause cancer-related deaths worldwide.The leaves of Morus alba L are traditional Chinese medicine widely applied in respiratory diseases.Our previous work has demonstrated the anti-lung cancer effect of secondary metabolites of mulberry leaf,but their mechanism of action has still not fully elucidated.We synthesized Moracin N(MAN)-Probe conjugated with alkyne to label lung cancer cells and identified protein targets by chemical proteomic analysis.MAN and its probe exerted similar growth-inhibitory effect on human lung cancer cells.Chemical proteomic results showed that MAN targeted the programmed death ligand 1(PD-L1)checkpoint pathway and T cell receptor(TCR)signaling pathway,indicating its immune-regulatory function.Cell-free surface plasmon resonance(SPR)results showed the direct interaction of MAN with PD-L1 protein.Molecular docking analysis demonstrated that MAN bound to E158 residue of PD-L1 protein.MAN downregulated the expression levels of PD-L1 in a time-and dose-dependent manner and disrupted the PD-L1/programmed death 1(PD-1)binding,including other secondary metabolites of mulberry leaves Guangsangon E(GSE)and Chalcomoracin(CMR).Human peripheral blood mononuclear cells(PBMCs)co-cultured with MAN-treated A549 cells,resulting in the increase of CD8+GZMB+T cells and the decrease of CD8+PD-1+T cells.It suggested that MAN exerts anti-cancer effect through blocking the PD-L1/PD-1 signaling.In vivo,MAN combined with anti-PD-1 antibody significantly inhibited lung cancer development and metastasis,indicating their synergistic effect.Taken together,secondary metabolites of mulberry leaves target the PD-L1/PD-1 signaling,enhance T cell-mediated immunity and inhibit the tumorigenesis of lung cancer.Their modulatory effect on tumor microenvironment makes them able to enhance the therapeutic efficacy of immune checkpoint inhibitors in lung cancer.

Abstract: Objective Based on the results of previous studies that diabetic foot is the most common type of chronic wound in Hainan, the study aims to clarify the severity of diabetic foot residents and the risk factors of diabetic foot gangrene in Hainan Island, and to provide a scientific basis for reducing the incidence of amputation in diabetic foot patients. Methods A total of 457 diabetic foot patients from 19 hospitals in 11 cities and counties in Hainan Province were investigated from July 2022 to June 2023 using a survey design. The data collected included demographic characteristics, diabetes, and diabetic foot information. Counting data were described by frequency and percentage, and chi-square test was used for the comparison of differences between groups. A binary Logistic regression multi-factor analysis was used, and an incremental model was set up in the regression to test the impact of potential confounding factors on the results. Results The incidence of gangrene in diabetic foot patients in Hainan is 56.01% (95%CI: 51.21%-61.49%), which is higher than that in other areas. Univariate analysis showed that age, lifestyle habits, medication, comorbidities, family history, and wound infection are associated with the risk of diabetic foot gangrene. Multivariate logistic regression analysis further confirmed that the independent risk factors for diabetic foot gangrene are not receiving diabetes medication, having complications/complications of diabetes, and not checking both feet daily. No significant interaction between gender and the above factors was found in the subgroup analysis. Conclusions The incidence of gangrene in diabetic foot patients in Hainan is higher than that in other areas, and the risk factors are related to the lack of standardized, timely treatment, and patients' lack of knowledge about diabetes and diabetic foot. It is suggested to speed up the construction of wound treatment centers in primary hospitals, improve the treatment level of diabetic foot, pay attention to the education of diabetes and diabetic foot, and improve patients' compliance with treatment, so as to achieve early detection, timely diagnosis and treatment, and reduce the severity of diabetic foot and the risk of gangrene.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Hepatic sinusoidal obstruction syndrome(HSOS),a toxic liver injury,can lead to multiple organ failure in severe cases and is even fatal.Early diagnosis is of great significance for the selection of treatment regimens and prognosis.Currently,ultrasound,as the preferred diagnostic method for liver diseases,has been recommended in expert consensus and criteria for the diagnosis of HSOS.However,there are no definitive ima-ging diagnostic standards.This paper summarizes the sonographic features of ultrasound and new ultrasound tech-nologies in HSOS research.Analyzing the characteristic sonographic images from gray-scale ultrasonography,Doppler ultrasonography,ultrasound elastography,and contrast-enhanced ultrasonography at different stages of the dis-ease enables the establishment and refining of the corresponding imaging diagnostic standards and provides effec-tive auxiliary examination methods for the early diagnosis and differential diagnosis of HSOS.

Objective:To evaluate the clinical value of four dimensional ultrasound combined with pelvic floor surface electromyography in the assessment of bladder prolapse in primipara with different delivery modes.Methods:A total of 413 primipara 6-8 weeks after full-term delivery were selected from the obstetrics clinic of the Second Affiliated Hospital of Hainan Medical College from October 2021 to September 2023. They were divided into natural delivery group(349 cases) and cesarean section group(64 cases ). The characteristics of 4D pelvic floor ultrasound in the two groups were analyzed and summarized. Then 64 cases of primipara with pelvic floor surface electromyography were divided into bladder prolapse group (46 cases) and no bladder prolapse group(18 cases). The characteristics of four dimension ultrasound combined with pelvic floor surface electromyography in the two groups were analyzed, and the related risk factors of bladder prolapse were analyzed.Results:The bladder neck mobility and urethral rotation angle in the natural delivery group were higher than those in the cesarean section group (all P<0.05). Compared with the cesarean section group, the incidence of obvious prolapse and urethral infundibulation was higher in the natural delivery group, while the incidence of mild prolapse was lower than that in the cesarean section group (all P<0.05). Bladder neck mobility, urethral rotation angle and levator ani hiatal area in the prolapsed bladder group were higher than those in the non-prolapsed bladder group (all P<0.05). The maximum value of fast muscle stage and the mean value of slow muscle stage in the group with prolapse were lower than those in the group without prolapse (both P<0.05). Univariate Logistic regression analysis found that the risk factors for bladder prolapse were increased birth weight, natural delivery, increased bladder neck mobility, posterior bladder angle was opened, increased urethral rotation angle, increased levator ani hiatal area, decreased maximum value of fast muscle stage and decreased mean value of slow muscle stage. Multivariate Logistic regression analysis showed that increased ani hiatal area ( OR=2.216, P=0.015) and decreased maximum value of tater muscle stage ( OR=0.847, P=0.035) were risk factors for bladder prolapse. Conclusions:Pelvic floor ultrasound combine with pelvic floor surface electromyography can qualitatively and quantitatively evaluate the changes of pelvic floor muscle structure and function in postpartum women, and diagnose bladder prolapse and its degree. The increase of levator ani hiatal area and the decrease of maximum value of tater stage may be the risk factors for bladder prolapse at 6-8 weeks postpartum in primiparas.