Objective:To explore the potential mechanism underlying IL-6 production through the TLR7 signaling pathway,which regulates Th17 cell differentiation in the context of Coxsackievirus B3(CVB3)-induced acute viral myocarditis(AVMC).Meth-ods:A total of 110 patients diagnosed with AVMC were admitted to Quanzhou First Hospital,Fujian between January 2020 and Janu-ary 2023,alongside 93 healthy volunteers.CD4+T cells were isolated from the subjects'blood,and the levels of CVB3 and the number of Th17 cells were assessed.Subsequently,CD4+T cells were infected with CVB3,and the levels of Th17 cells,IL-17,IL-21,and TNF-α were measured.After knockdown of TLR7 or treatment with TLR7 inhibitors,the differentiation of CVB3-infected CD4+T cells into Th17 cells was observed.Results:In comparison to healthy controls,AVMC patients exhibited elevated plasma levels of hsCRP,IL-17,IL-21,and TNF-α(P<0.05).The levels of CVB3 mRNA in CD4+T cells were also notably higher in AVMC patients compared to healthy controls(P<0.05).The mean viral titer in AVMC patients measured 230 PFU/ml,while no detectable virus was found in healthy volunteers(P<0.05).In CD4+T cells,the count of Th17 cells was significantly increased in AVMC patients compared to healthy volunteers(P<0.05).Moreover,the number of Th17 cells in peripheral blood CD4+T cells of AVMC patients showed a positive correlation with CVB3 virus titer(P<0.05).Following CVB3 infection,the number of Th17 cells increased compared with the control group(P<0.05),accompanied by elevated levels of IL-17,IL-21,and TNF-α in the supernatant(P<0.05).Knockdown of TLR7 and CVB3 infection in CD4+T cells significantly reduced the levels of Th17 cells(P<0.05),while the expression level of phosphorylated-activated TLR7 increased significantly after CVB3 infection of CD4+T cells compared to the control group(P<0.05).Treatment with the TLR7 inhibitor M5049 and CVB3 infection led to a significant decrease in Th17 cell levels(P<0.05).The secretion of IL-6 in CD4+T cells increased after CVB3 infection(P<0.05),and this increase was mitigated by TLR7 knockdown and CVB3 infection(P<0.05)as well as TLR7 inhibitor M5049 treatment and CVB3 infection(P<0.05).Conclusion:CVB3 activates TLR7 via phosphoryla-tion,prompting CD4+T cells to release IL-6 and undergo differentiation into Th17 cells.Consequently,TLR7 emerges as a promising therapeutic target for AVMC.

Objective:To explore the potential mechanism underlying IL-6 production through the TLR7 signaling pathway,which regulates Th17 cell differentiation in the context of Coxsackievirus B3(CVB3)-induced acute viral myocarditis(AVMC).Meth-ods:A total of 110 patients diagnosed with AVMC were admitted to Quanzhou First Hospital,Fujian between January 2020 and Janu-ary 2023,alongside 93 healthy volunteers.CD4+T cells were isolated from the subjects'blood,and the levels of CVB3 and the number of Th17 cells were assessed.Subsequently,CD4+T cells were infected with CVB3,and the levels of Th17 cells,IL-17,IL-21,and TNF-α were measured.After knockdown of TLR7 or treatment with TLR7 inhibitors,the differentiation of CVB3-infected CD4+T cells into Th17 cells was observed.Results:In comparison to healthy controls,AVMC patients exhibited elevated plasma levels of hsCRP,IL-17,IL-21,and TNF-α(P<0.05).The levels of CVB3 mRNA in CD4+T cells were also notably higher in AVMC patients compared to healthy controls(P<0.05).The mean viral titer in AVMC patients measured 230 PFU/ml,while no detectable virus was found in healthy volunteers(P<0.05).In CD4+T cells,the count of Th17 cells was significantly increased in AVMC patients compared to healthy volunteers(P<0.05).Moreover,the number of Th17 cells in peripheral blood CD4+T cells of AVMC patients showed a positive correlation with CVB3 virus titer(P<0.05).Following CVB3 infection,the number of Th17 cells increased compared with the control group(P<0.05),accompanied by elevated levels of IL-17,IL-21,and TNF-α in the supernatant(P<0.05).Knockdown of TLR7 and CVB3 infection in CD4+T cells significantly reduced the levels of Th17 cells(P<0.05),while the expression level of phosphorylated-activated TLR7 increased significantly after CVB3 infection of CD4+T cells compared to the control group(P<0.05).Treatment with the TLR7 inhibitor M5049 and CVB3 infection led to a significant decrease in Th17 cell levels(P<0.05).The secretion of IL-6 in CD4+T cells increased after CVB3 infection(P<0.05),and this increase was mitigated by TLR7 knockdown and CVB3 infection(P<0.05)as well as TLR7 inhibitor M5049 treatment and CVB3 infection(P<0.05).Conclusion:CVB3 activates TLR7 via phosphoryla-tion,prompting CD4+T cells to release IL-6 and undergo differentiation into Th17 cells.Consequently,TLR7 emerges as a promising therapeutic target for AVMC.

Objective To observe the value of right ventricular free wall longitudinal strain(RVFWLS)to pulmonary artery systolic pressure(PASP)ratio(RVFWLS/PASP)for evaluating systolic function of right ventricle(RV)in patients with hypertrophic cardiomyopathy(HCM).Methods Fifty-two HCM patients were retrospectively collected and divided into group A(RVFWLS/PASP≤0.75,n=26)and B(RVFWLS/PASP＞0.75,n=26)according to median RVFWLS/PASP.Meanwhile,26 healthy individuals were included as control group.Parameters of echocardiography and speckle tracking imaging(STI)were obtained and compared among 3 groups.The correlations of RVFWLS/PASP and other parameters were analyzed with linear regression.Results In group A and B,left ventricular ejection fraction(LVEF),RV septal longitudinal strain(RVSepLS),RVFWLS,RV end-diastolic volume index(RVEDVi),RV stroke volume(RVSV),RV fractional area change(RVFAC)and left ventricular global longitudinal strain(LVGLS)were all lower,while the ratio of peak E blood flow velocity at mitral orifice diastole to early mitral intervalal annulus diastole velocity(E/e′)were higher than those in control group(all adjusted P＜0.05).Compared with group B and control group,group A had higher PASP but lower RV ejection fraction(RVEF)(all adjusted P＜0.05).Furthermore,RVFWLS and LVGLS were both lower in group A than in group B(both adjusted P＜0.05).Linear regression analysis showed that RVSepLS and RVEF were independently linearly related to RVFWLS/PASP(both P＜0.05).Conclusion RVFWLS/PASP could be used to monitor changes of RV systoic function in HCM patients at early stage.

Objective To observe the value of right ventricular free wall longitudinal strain(RVFWLS)to pulmonary artery systolic pressure(PASP)ratio(RVFWLS/PASP)for evaluating systolic function of right ventricle(RV)in patients with hypertrophic cardiomyopathy(HCM).Methods Fifty-two HCM patients were retrospectively collected and divided into group A(RVFWLS/PASP≤0.75,n=26)and B(RVFWLS/PASP＞0.75,n=26)according to median RVFWLS/PASP.Meanwhile,26 healthy individuals were included as control group.Parameters of echocardiography and speckle tracking imaging(STI)were obtained and compared among 3 groups.The correlations of RVFWLS/PASP and other parameters were analyzed with linear regression.Results In group A and B,left ventricular ejection fraction(LVEF),RV septal longitudinal strain(RVSepLS),RVFWLS,RV end-diastolic volume index(RVEDVi),RV stroke volume(RVSV),RV fractional area change(RVFAC)and left ventricular global longitudinal strain(LVGLS)were all lower,while the ratio of peak E blood flow velocity at mitral orifice diastole to early mitral intervalal annulus diastole velocity(E/e′)were higher than those in control group(all adjusted P＜0.05).Compared with group B and control group,group A had higher PASP but lower RV ejection fraction(RVEF)(all adjusted P＜0.05).Furthermore,RVFWLS and LVGLS were both lower in group A than in group B(both adjusted P＜0.05).Linear regression analysis showed that RVSepLS and RVEF were independently linearly related to RVFWLS/PASP(both P＜0.05).Conclusion RVFWLS/PASP could be used to monitor changes of RV systoic function in HCM patients at early stage.

Objective:To evaluate the effect of umbilical cord milking (UCM) on neonatal outcomes after cesarean section.Methods:Chinese and English databases (including CNKI, Wanfang, China Biology Medicine Disc, VIP, Yiigle, PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and Google Scholar) and ClinicalTrials.gov were retrieved from the inception to July 2023. Randomized controlled trials regarding UCM in neonates from different races who were born by cesarean section were included. The outcomes were postnatal hemoglobin level, hematocrit value, peak serum bilirubin level, phototherapy, cord blood pH value, intraventricular hemorrhage, death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score. The risk of bias among the included studies was confined to low or possible risk according to the Cochrane Risk of Bias Assessment Tool 2.0. RevMan5.3 was used for meta-analysis, and subgroup analysis was performed among neonates with different gestational ages. The certainty of evidence was evaluated using the grades of recommendations assessment, development, and evaluation (GRADE) framework.Results:A total of 11 articles involving 2 347 neonates (1 322 full-term and 1 025 preterm infants) were included. Meta-analysis results showed that: (1) Compared with the immediate cord clamping, UCM increased the hemoglobin level within 24 h and 48-72 h after birth ( MD=1.40, 95% CI: 1.11-1.70, Z=9.32; MD=0.86, 95% CI: 0.69-1.02, Z=10.02, both P<0.01), hematocrit value within 24 h and 48-72 h after birth ( MD=2.73, 95% CI: 0.18-5.29, Z=2.09, P=0.04; MD=3.57, 95% CI: 2.29-4.85, Z=5.46, P<0.01). However, no significant differences were found in the peak bilirubin level, phototherapy, cord blood pH, and Apgar score at 1 and 5 min (all P>0.05). (2) Compared with delayed cord clamping, UCM increased the hemoglobin level ( MD=0.83, 95% CI: 0.75-0.91, Z=20.11, P<0.01) and hematocrit value ( MD=2.34, 95% CI: 1.25-3.43, Z=4.20, P<0.01) within 24 h after birth, but not in the hematocrit value at 48-72 h after birth ( MD=－0.38, 95% CI:－2.27-1.52, Z=0.39, P=0.70) or the peak bilirubin level ( MD=－0.65, 95% CI:－2.16-1.04, Z=0.69, P=0.49). Sensitivity analysis showed that for full-term neonates born by cesarean section, the peak bilirubin level in the UCM group was significantly lower than that in the delayed cord clamping group ( MD=－1.30, 95% CI:－2.26-0.34, Z=2.66, P<0.01). Still, the incidence of phototherapy, intraventricular hemorrhage (grade Ⅰ-Ⅳ), death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score at 1 min and 5 min showed no statistical differences (all P>0.05). Conclusions:UCM could increase the short-term postnatal hemoglobin and hematocrit levels in neonates born by cesarean section, which might prevent neonatal anemia in the short term without increasing the adverse neonatal outcomes. Little effects were observed on the peak bilirubin level, phototherapy, polycythemia, etc. More high-quality and large-sample randomized controlled trials are needed in the future.

Objective:To establish a scientific and comprehensive evaluation index system for teaching ability of dental specialist nurses, providing a basis for the selection and assessment of dental nursing instructors.Methods:Based on literature analysis, semi-structured interviews, and group discussions, preliminary evaluation indicators were formulated. From February to April 2023, the Delphi method was used to conduct two rounds of consultation with 27 experts from six provinces and municipalities in China to determine the evaluation index system for the teaching ability of dental specialist nurses. The analytic hierarchy process (AHP) was used to determine the weights of each indicator and its combined weight.Results:The authority coefficient of 27 experts was 0.895. In the two rounds of expert consultation, the effective response rates of the questionnaire were all 100% (27/27), and the Kendall harmony coefficients of various indicators were 0.179 to 0.240 and 0.200 to 0.261 respectively ( P<0.01). The final evaluation index system for teaching ability of dental specialist nurses was formed, including six primary indicators, 15 secondary indicators, and 71 tertiary indicators. Conclusions:The evaluation index system for teaching ability of dental specialist nurses has a reasonable structure, a scientific and rigorous construction process, and can provide a theoretical basis for the allocation of dental specialist human resources and nursing training assessment.

Objective::To assess the role of a nurse-assisted early warning intervention in improving prophylaxis against obstetric venous thromboembolism (VTE) and preventing VTE following cesarean delivery (CD).Methods::A prospective cohort study conducted between January 1, 2020, and December 30, 2022, enrolled pregnant women who underwent CD in the obstetric unit of Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital. The patients were assigned to a control group (routine nursing care) or the intervention group (nurse-assisted early warning intervention) depending on whether or not the nurse-assisted early warning intervention had been implemented. The χ2 test and Student’s t-test were used for statistical analysis. The primary outcome was the incidence of systemic VTE following CD, and secondary outcomes were the rates of mechanical or pharmacologic prophylaxis receipts for VTE and the frequency and severity of adverse events related to pharmacologic prophylaxis. Results::A total of 27,074 cases were enrolled. The incidence of symptomatic VTE following CD was significantly lower in the intervention group (0.29 per 1000 deliveries) than in the control group (2.4 per 1000 deliveries) ( P < 0.001). Significantly more cases received mechanical and pharmacological VTE prophylaxis in the intervention group than in the control group (respectively, 19.8% vs. 12.6% receiving mechanical prophylaxis and 0.9% vs. 0.2% receiving pharmacological prophylaxis). No cases of life-threatening bleeding occurred in either group. Conclusion::The application of nurse-assisted early warning intervention may be an effective method for preventing VTE following CD.

Objective::To assess the role of a nurse-assisted early warning intervention in improving prophylaxis against obstetric venous thromboembolism (VTE) and preventing VTE following cesarean delivery (CD).Methods::A prospective cohort study conducted between January 1, 2020, and December 30, 2022, enrolled pregnant women who underwent CD in the obstetric unit of Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital. The patients were assigned to a control group (routine nursing care) or the intervention group (nurse-assisted early warning intervention) depending on whether or not the nurse-assisted early warning intervention had been implemented. The χ2 test and Student’s t-test were used for statistical analysis. The primary outcome was the incidence of systemic VTE following CD, and secondary outcomes were the rates of mechanical or pharmacologic prophylaxis receipts for VTE and the frequency and severity of adverse events related to pharmacologic prophylaxis. Results::A total of 27,074 cases were enrolled. The incidence of symptomatic VTE following CD was significantly lower in the intervention group (0.29 per 1000 deliveries) than in the control group (2.4 per 1000 deliveries) ( P < 0.001). Significantly more cases received mechanical and pharmacological VTE prophylaxis in the intervention group than in the control group (respectively, 19.8% vs. 12.6% receiving mechanical prophylaxis and 0.9% vs. 0.2% receiving pharmacological prophylaxis). No cases of life-threatening bleeding occurred in either group. Conclusion::The application of nurse-assisted early warning intervention may be an effective method for preventing VTE following CD.

OBJECTIVE To provide reference for the construction of remote inspection mode of pharmaceutical production in China. METHODS By combing the guidance documents of remote inspection and related pilots issued abroad， the experience of constructing remote inspection mode of pharmaceutical production was summarized. RESULTS & CONCLUSIONS Typical foreign countries and regions have carried out remote inspection pilots all over the world， and clearly defined the application situation， implementation process， inspection techniques and related points for attention of remote inspection of pharmaceutical production. In terms of application， the European Union pointed out four specific applicable situations， including travel restrictions， while the United States stipulated that remote inspection was applicable to pre-approved inspection and so on. In terms of the implementation process， the United States developed a four-step method of remote inspection， while the European Union has defined the specific implementation process of remote inspection in more detail. In comparison， Japan paid more attention to the remote inspection process of production documents. In terms of inspection techniques， the European Union used 360° cameras， Matterport 3D technology and document review software to realize the remote inspection of production sites and production documents. In terms of attention points for remote inspection， the United States required that access rights should be set for information sharing to avoid information disclosure. Both the European Union and the United States required inspectors to be trained and equipment inspected before remote inspection. It is suggested that China should formulate unified guidelines for remote inspection of pharmaceutical production， clarify the applicable situations， and formulate the implementation process of remote inspection of pharmaceutical production with reference to the opinions of drug manufacturers. In addition， intelligent remote inspection technology can be used in combination with the information construction level of drug manufacturers， and remote inspection training program can be formulated to cultivate professional remote inspection team.

Objective:To construct the index system for nurses' job competency in children's dental general anesthesia treatment, so as to provide a reference for formulating job admission assessment standards and nurses training strategies.Methods:Research was carried out from July to November 2021. Taking the "job competency model for specialist nurses-iceberg model" as the theoretical framework, the first draft of the indicators was initially prepared by the method of literature review and behavioral event interview. Through the Delphi method, 26 stomatology experts at home and abroad were inquired by letters. Combined with the analytic hierarchy process, the evaluation indicators and weights of the index system for nurses' job competency in children's dental general anesthesia treatment were determined.Results:In the first round, 26 experts completed the letter inquiries, and in the second round, 24 experts completed the letter inquiries, the effective recovery rates of the questionnaires were 100.00% and 92.31%, respectively, the expert authority coefficients were 0.844 and 0.856, and the Kendall harmony coefficients were 0.242 and 0.289, respectively. Finally, the index system for nurses' job competency in children's dental general anesthesia treatment was formed, including 4 first-level indicators, 11 second-level indicators, and 58 third-level indicators.Conclusions:The index system for nurses' job competency in children's dental general anesthesia treatment is scientific, reliable, and in line with clinical practice. It can provide quantitative standards for the comprehensive training of children's dental general anesthesia treatment with nurses and job admission assessment, so as to promote the effectiveness of quality of nursing and safety management.