BACKGROUND:D1-3-n-butylphthalide has antioxidant and anti-inflammatory effects and has been explored to have protective role in Parkinson's disease,but the underlying mechanisms are unknown.OBJECTIVE:To investigate the protective effect of D1-3-n-butylphthalide by the approach of network pharmacology,molecular docking,and cellular experimental validation.METHODS:(1)Network pharmacology and molecular docking:The database was used to screen the targets of D1-3-n-butylphthalide and Parkinson's disease.The intersection was taken from the construction of the target protein interaction network,and then screen the core targets.The GO and KEGG pathway enrichment was used to further analyze the core targets.The interaction between the target proteins and D1-3-n-butylphthalide was verified by molecular docking.(2)Cell validation:The passage 6 PC12 cells were divided into six groups for culture.The control group was cultured with conventional culture medium.The model group was cultured with N-methyl-4-phenylpyridinium iodide to induce Parkinson's disease model.The ML385 inhibitor group was added with nuclear factor E2-related factor 2 inhibitor ML385 on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide treatment group was added with butylphthalide on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide combined with ML385 treatment group was added with D1-3-n-butylphthalide and ML385 on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide group was cultured with conventional culture medium containing butylphthalide alone.Cell proliferation,intracellular reduced glutathione and malondialdehyde levels,and protein expression of protein kinase B/glycogen synthase kinase 3β/nuclear factor E2-related factor 2(AKT/GSK-3β/Nrf2)signaling pathway were detected.RESULTS AND CONCLUSION:(1)A total of 52 targets were screened for the intersection of drugs and disease targets,and the core targets including the matrix metalloproteinase 9 and GSK-3β were involved the phosphatidylinositol 3-kinase(PI3K)/AKT and oxidative stress-related signaling pathways.The molecular docking binding energy of D1-3-n-butylphthalide and GSK-3β was-18.27 kJ/mol,which indicated that D1-3-n-butylphthalide had a good binding ability with GSK-3β.(2)Compared with the model group,the PC12 cell activity and reduced glutathione level in the D1-3-n-butylphthalide treatment group were increased(P＜0.05),the malondialdehyde level was decreased(P＜0.05),and the expression of p-AKT,p-GSK-3β,Nu-Nrf2,and T-Nrf2 proteins was increased(P＜0.05).Compared with the D1-3-n-butylphthalide group,the PC12 cell activity and reduced glutathione level in the D1-3-n-butylphthalide combined with ML385 treatment group were decreased(P＜0.05),the malondialdehyde level was increased(P＜0.05),and the expression of Nu-Nrf2 and T-Nrf2 proteins was decreased(P＜0.05).(3)These results demonstrate that D1-3-n-butylphthalide can inhibit oxidative stress and improve cell activity through the AKT/GSK-3β/Nrf2 signaling pathway,and has a protective effect on the Parkinson's cell model induced by N-methyl-4-phenylpyridinium iodide.

Objective To explore the application effect of team-based learning(TBL)teaching method combined with scenario simulation in the team-based cardiopulmonary resuscitation(CPR)training for standardized training of resident physicians in department of emergency.Methods A total of 86 standardized training resident physicians rotating in the department of emergency of Guangdong Provincial People's Hospital Southern Medical University from May 2022 to July 2023 were included as study subjects.These resident physicians were divided into a control group(n=42)and an observation group(n=44)according to different teaching methods.The control group was taught using the conventional teaching method,whereas the observation group was taught using a combination of TBL and scenario simulation-based method.The difference of theoretical assessment scores,practical skill competency and training satisfaction were compared before and after training between groups.Results The theoretical and practice skill assessment scores of both groups significantly improved after training(all P<0.05).However,there was no significant difference in the theoretical assessment scores or the score increase between the two groups before and after training.In the subcategory of theoretical assessment scores,the observation group had significantly higher points than the control group in the precautions category after training(21.09±2.07 vs.20.07±1.85,P<0.05).Compared with the control group,the observation group had significantly higher post-training practical skill scores and a significantly greater score increase(scores:86.77±3.89 vs.81.17±4.18,score increase:11±5.15 vs.8±4.60,both P<0.05).Among the subcategory practical skill scores,the observation group outperformed the control group in communication skills,emergency skills and teamwork+humanistic care(communication skills points:21.36±1.71 vs.20.07±1.54,emergency skills points:21.73±1.35 vs.20.21±1.79,teamwork+humanistic care points:22.27±1.76 vs.19.71±2.71,all P<0.05).The degree of satisfaction in overall training satisfaction,the novelty of the teaching method,teacher affinity,interests in learning,developing teamwork ability,class atmosphere,communication and expression ability,and confidence in skill mastery were significantly higher in the observation group than in the control group[overall training satisfaction:97.73%(43/44)vs.50.00%(21/42),the novelty of the teaching method:90.91%(40/44)vs.47.62%(20/42),teacher affinity:93.18%(41/44)vs.57.14%(24/42),interests in learning:97.73%(43/44)vs.59.52%(25/42),developing teamwork ability:95.45%(42/44)vs.52.38%(22/42),class atmosphere:93.18%(41/44)vs.57.14%(24/42),improve communication and expression ability:100.00%(44/44)vs.50.00%(21/42),and confidence in skill mastery:93.18%(41/44)vs.45.24%(19/42),all P<0.05].Conclusion The application of TBL teaching method combined with scenario simulation in CPR training for standardized training of resident physicians can effectively improve quality of clinical skill training.

Objective:To systematically evaluate the fairness of traditional Chinese medicine (TCM) healthcare resource allocation at the prefecture-level in China using the healthcare resource agglomeration degree (HRAD) method, so as to provide empirical evidence for optimizing resource distribution.Methods:Data on TCM healthcare resources (including the number of TCM institutions, public TCM hospitals, TCM hospital beds, and TCM healthcare technicians) were collected from 333 prefecture-level regions in 2023. The HRAD method was employed to assess fairness in geographic allocation (HRAD i) and population-based allocation (HRAD i/PAD i). A multi-indicator comprehensive evaluation was conducted using the entropy weight method to determine weighting coefficients. Results:Significant disparities were observed in the geographic agglomeration of TCM resources (HRAD i) in China. Resource-rich regions (HRAD i>5) were primarily concentrated in eastern and some central-western provinces, while resource-scarce regions (HRAD i<1) were mainly distributed in western, northeastern, and parts of central and eastern provinces. Analysis of population-based fairness (HRAD i/PAD i) revealed that most prefecture-level cities nationwide had ratios<1, with only 8 provinces having more cities with ratios>1 than<1. The comprehensive evaluation showed that top-ranked cities in the east (e.g., Hangzhou, Dongying, Shenzhen), central region (e.g., Taiyuan, Zhengzhou), and west (e.g., Hainan Prefecture, Alxa League) were predominantly core cities or sparsely populated areas. Conclusions:China′s prefecture-level TCM healthcare resource allocation exhibits significant geographic and population-based inequities, with excessive concentration in provincial capitals and developed cities. Urgent strategies are needed to optimize resource allocation, enhance fairness and accessibility, including promoting the decentralization of high-quality resources, strengthening regional collaborative support, enhancing talent attraction in underdeveloped areas, and leveraging information technology to improve efficiency.

BACKGROUND:D1-3-n-butylphthalide has antioxidant and anti-inflammatory effects and has been explored to have protective role in Parkinson's disease,but the underlying mechanisms are unknown.OBJECTIVE:To investigate the protective effect of D1-3-n-butylphthalide by the approach of network pharmacology,molecular docking,and cellular experimental validation.METHODS:(1)Network pharmacology and molecular docking:The database was used to screen the targets of D1-3-n-butylphthalide and Parkinson's disease.The intersection was taken from the construction of the target protein interaction network,and then screen the core targets.The GO and KEGG pathway enrichment was used to further analyze the core targets.The interaction between the target proteins and D1-3-n-butylphthalide was verified by molecular docking.(2)Cell validation:The passage 6 PC12 cells were divided into six groups for culture.The control group was cultured with conventional culture medium.The model group was cultured with N-methyl-4-phenylpyridinium iodide to induce Parkinson's disease model.The ML385 inhibitor group was added with nuclear factor E2-related factor 2 inhibitor ML385 on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide treatment group was added with butylphthalide on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide combined with ML385 treatment group was added with D1-3-n-butylphthalide and ML385 on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide group was cultured with conventional culture medium containing butylphthalide alone.Cell proliferation,intracellular reduced glutathione and malondialdehyde levels,and protein expression of protein kinase B/glycogen synthase kinase 3β/nuclear factor E2-related factor 2(AKT/GSK-3β/Nrf2)signaling pathway were detected.RESULTS AND CONCLUSION:(1)A total of 52 targets were screened for the intersection of drugs and disease targets,and the core targets including the matrix metalloproteinase 9 and GSK-3β were involved the phosphatidylinositol 3-kinase(PI3K)/AKT and oxidative stress-related signaling pathways.The molecular docking binding energy of D1-3-n-butylphthalide and GSK-3β was-18.27 kJ/mol,which indicated that D1-3-n-butylphthalide had a good binding ability with GSK-3β.(2)Compared with the model group,the PC12 cell activity and reduced glutathione level in the D1-3-n-butylphthalide treatment group were increased(P＜0.05),the malondialdehyde level was decreased(P＜0.05),and the expression of p-AKT,p-GSK-3β,Nu-Nrf2,and T-Nrf2 proteins was increased(P＜0.05).Compared with the D1-3-n-butylphthalide group,the PC12 cell activity and reduced glutathione level in the D1-3-n-butylphthalide combined with ML385 treatment group were decreased(P＜0.05),the malondialdehyde level was increased(P＜0.05),and the expression of Nu-Nrf2 and T-Nrf2 proteins was decreased(P＜0.05).(3)These results demonstrate that D1-3-n-butylphthalide can inhibit oxidative stress and improve cell activity through the AKT/GSK-3β/Nrf2 signaling pathway,and has a protective effect on the Parkinson's cell model induced by N-methyl-4-phenylpyridinium iodide.

Objective To explore the application effect of team-based learning(TBL)teaching method combined with scenario simulation in the team-based cardiopulmonary resuscitation(CPR)training for standardized training of resident physicians in department of emergency.Methods A total of 86 standardized training resident physicians rotating in the department of emergency of Guangdong Provincial People's Hospital Southern Medical University from May 2022 to July 2023 were included as study subjects.These resident physicians were divided into a control group(n=42)and an observation group(n=44)according to different teaching methods.The control group was taught using the conventional teaching method,whereas the observation group was taught using a combination of TBL and scenario simulation-based method.The difference of theoretical assessment scores,practical skill competency and training satisfaction were compared before and after training between groups.Results The theoretical and practice skill assessment scores of both groups significantly improved after training(all P<0.05).However,there was no significant difference in the theoretical assessment scores or the score increase between the two groups before and after training.In the subcategory of theoretical assessment scores,the observation group had significantly higher points than the control group in the precautions category after training(21.09±2.07 vs.20.07±1.85,P<0.05).Compared with the control group,the observation group had significantly higher post-training practical skill scores and a significantly greater score increase(scores:86.77±3.89 vs.81.17±4.18,score increase:11±5.15 vs.8±4.60,both P<0.05).Among the subcategory practical skill scores,the observation group outperformed the control group in communication skills,emergency skills and teamwork+humanistic care(communication skills points:21.36±1.71 vs.20.07±1.54,emergency skills points:21.73±1.35 vs.20.21±1.79,teamwork+humanistic care points:22.27±1.76 vs.19.71±2.71,all P<0.05).The degree of satisfaction in overall training satisfaction,the novelty of the teaching method,teacher affinity,interests in learning,developing teamwork ability,class atmosphere,communication and expression ability,and confidence in skill mastery were significantly higher in the observation group than in the control group[overall training satisfaction:97.73%(43/44)vs.50.00%(21/42),the novelty of the teaching method:90.91%(40/44)vs.47.62%(20/42),teacher affinity:93.18%(41/44)vs.57.14%(24/42),interests in learning:97.73%(43/44)vs.59.52%(25/42),developing teamwork ability:95.45%(42/44)vs.52.38%(22/42),class atmosphere:93.18%(41/44)vs.57.14%(24/42),improve communication and expression ability:100.00%(44/44)vs.50.00%(21/42),and confidence in skill mastery:93.18%(41/44)vs.45.24%(19/42),all P<0.05].Conclusion The application of TBL teaching method combined with scenario simulation in CPR training for standardized training of resident physicians can effectively improve quality of clinical skill training.

Objective:To systematically evaluate the fairness of traditional Chinese medicine (TCM) healthcare resource allocation at the prefecture-level in China using the healthcare resource agglomeration degree (HRAD) method, so as to provide empirical evidence for optimizing resource distribution.Methods:Data on TCM healthcare resources (including the number of TCM institutions, public TCM hospitals, TCM hospital beds, and TCM healthcare technicians) were collected from 333 prefecture-level regions in 2023. The HRAD method was employed to assess fairness in geographic allocation (HRAD i) and population-based allocation (HRAD i/PAD i). A multi-indicator comprehensive evaluation was conducted using the entropy weight method to determine weighting coefficients. Results:Significant disparities were observed in the geographic agglomeration of TCM resources (HRAD i) in China. Resource-rich regions (HRAD i>5) were primarily concentrated in eastern and some central-western provinces, while resource-scarce regions (HRAD i<1) were mainly distributed in western, northeastern, and parts of central and eastern provinces. Analysis of population-based fairness (HRAD i/PAD i) revealed that most prefecture-level cities nationwide had ratios<1, with only 8 provinces having more cities with ratios>1 than<1. The comprehensive evaluation showed that top-ranked cities in the east (e.g., Hangzhou, Dongying, Shenzhen), central region (e.g., Taiyuan, Zhengzhou), and west (e.g., Hainan Prefecture, Alxa League) were predominantly core cities or sparsely populated areas. Conclusions:China′s prefecture-level TCM healthcare resource allocation exhibits significant geographic and population-based inequities, with excessive concentration in provincial capitals and developed cities. Urgent strategies are needed to optimize resource allocation, enhance fairness and accessibility, including promoting the decentralization of high-quality resources, strengthening regional collaborative support, enhancing talent attraction in underdeveloped areas, and leveraging information technology to improve efficiency.

OBJECTIVE To understand the development status and existing problems of traditional Chinese medicine(TCM)pharmacists in public TCM hospitals in China,aiming to provide suggestions for the competent departments to formulate management policies for TCM pharmacists and promote the healthy development of TCM.METHODS The data on the number and professional titles of TCM pharmacists in public TCM hospitals in China from 2019 to 2023 were collected.Descriptive analysis was employed to analyze the number,distribution and professional titles of TCM pharmacists in public TCM hospitals across the country,and to measure the quantity shortfalls of the number of TCM pharmacists in these hospitals.RESULTS From 2019 to 2023,the number of TCM pharmacists in public TCM hospitals in China grew slowly,with an average annual growth rate of 2.56%.However,the proportion of TCM pharmacists to the total number of pharmacists in public TCM hospitals gradually decreased,with an average annual growth rate of-0.65%.In terms of hospital grades,the number of TCM pharmacists in tertiary public TCM hospitals showed positive growth,while those in secondary and primary public TCM hospitals showed negative growth.In terms of hospital types,the average annual growth rate of TCM pharmacists in TCM hospitals was 2.22%,in integrated Chinese and Western medicine hospitals it was 7.97%,and in ethnic minority medicine hospitals it was 2.74%.The development of TCM pharmacists in different provinces was uneven.The annual growth rate of TCM pharmacists in Guizhou exceeded 10%,while the growth rate in Hunan and Heilongjiang was negative.In 2023,the number of TCM pharmacists per thousand population in public TCM hospitals was 0.03,indicating a relatively low staffing level.The professional titles of TCM pharmacists in public TCM hospitals were mainly primary and intermediate,with a total of 67.33%.According to the calculation that the proportion of TCM pharmacists to pharmacists was not less than 60%,public TCM hospitals and hospitals of integrated TCM and Western medicine should be reconfigured with TCM pharmacists 6 212 and 1 288 people,respectively.CONCLUSIONS The number of TCM pharmacists in public TCM hospitals is growing slowly,with insufficient staffing levels,relatively low professional titles,and uneven distribution and development across provinces.It is suggested that relevant competent departments strengthen policy guidance,increase the attention given by the state level to TCM pharmacists,strengthen the construction of the talent team for TCM pharmacists,improve the quality and optimize the allocation of TCM pharmacist talents in order to promote the high-quality development of TCM services.

Objective To explore abnormalities in functional connectivity of the affective network (AN) in relapse of major depressive disorder (MDD) after antidepressant treatment combined with resting state functional connectivity analysis.Methods Eleven recurrent MDD subjects after treatment,seventeen non recurrent MDD subjects after treatment and seventy-two healthy controls underwent fMRI scan.The amygdala,the pallidum,the insular cortex and the anterior cingulate cortex of the AN were selected as the template.Group independent component analysis (ICA) was performed to decompose the fMRI images into spatially independent components and the independent component which fit this template best was selected as AN.Two-sample t-tests were performed to investigate the changes in functional connectivity of the AN.Finally,the right amygdala and the medial prefrontal cortex were defined as seed regions.Results Compared with healthy control subjects and non-recurrent MDD group,recurrent MDD group showed significantly increased functional connectivity in the right amygdala in AN(P＜0.001).Meanwhile,the functional connectivity between the right amygdala and the medial prefrontal cortex was significantly decreased in recurrent MDD group(P ＜0.05).Conclusion Abnormal resting-state functional connectivity of the right amygdala after antidepressant treatment in MDD was found,suggesting that altered amygdala functional connectivity may serve as a predicator of relapse of the MDD.

Objective To determine the specific effect of manual removal of the placenta in the third stage of labor in the prevention of postpartum hemorrhage.Methods We searched PubMed,EMBASE,EBSCOhost databases and Chinese Academic Journal et al(inception to October August 2015).Articles database of all published.Randomized controlled trials comparing manual removal of the placenta with hands-off management inthe third stage of labor were included.Two independent reviewers assessed the included studies and extracted data.RevMan4.2 software was used for Meta-analysis.Results Six randomized controlled trials involving a total of 2 435 participants were eligible.There were five cases of cesarean section,one case of natural childbirth,and four English literatures and two Chinese literatures.Significant difference was found between manual removal of the placenta and handsoff management groups with respect to the incidence of postpartum hemorrhage.Conclusion Routine manual removal of placenta at cesarean section significantly increases perioperative blood loss.However,the effect in vaginal delivery need further research.

Objective To describe the condition of depression of the undergraduate nursing students in practice,and compare the differences of depression between male and female nursing students.Methods Using the Beck Depression Inventory (BDI) to investigate the undergraduate nursing students who were practicing in the Affiliated Hospital of Sun Yat-sen University from July 2011 to June 2012 and analyze the condition and gender-related differences of depression.Results The occurrence of depression was high in the undergraduate practical nurses(37.2％).The occurrence of depression in the male (41.2％)undergraduate practical nurses was higher than that in the female (34.6％) undergraduate practical nurses.The occurrence of depression was mostly light depression(16.3％) and middle depression (20.9％),no serious depression occurred.Conclusions The higher occurrence of depression in the undergraduate practical nurses and the gender-related differences signify the importance of psychological problems.