Objective To establish a method for simultaneous determination of four high-molecular-weight thiol derivatives (TDs) in workplace air by gas chromatography. Methods The four kinds of vapor-phase macromolecular TDs (1-pentanethiol, 1-hexanethiol, 1-benzyl mercaptan, and n-octanethiol) in the workplace air were collected using the GDH-1 air sampling tubes, desorbed with anhydrous ethanol, separated on a DB-FFAP capillary column, and determined by flame ionization detector. Results The quantitation range of the four TDs was 0.30-207.37 mg/L, with the correlation coefficients greater than 0.999 00. The minimum detection mass concentrations and minimum quantitation mass concentrations were 0.18-0.32 and 0.60-1.05 mg/m³, respectively (both calculated based on the 1.5 L sample and 3.0 mL desorption solvent). The mean desorption efficiencies ranged from 87.07% to 103.59%. The within-run and between-run relative standard deviations were 1.92%-8.22% and 1.89%-8.45%, respectively. The samples can be stored at room temperature or 4 ℃ for three days and up to 7 days at -18 ℃. Conclusion This method is suitable for the simultaneous determination of four vapor-phase TDs in workplace air.

Objective To explore the safety and effects of alpha-lipoic acid (ALA) in patients with ischemic heart failure (IHF). Methods A randomized, double-blind, placebo-controlled trial was designed (ClinicalTrial.gov registration number NCT03491969). From January 2019 to January 2023, 300 patients with IHF were enrolled in four medical centers in China, and were randomly assigned at a 1∶1 ratio to receive ALA (600 mg daily) or placebo on top of standard care for 24 months. The primary outcome was the composite outcome of hospitalization for heart failure (HF) or all-cause mortality events. The second outcome included non-fatal myocardial infarction (MI), non-fatal stroke, changes of left ventricular ejection fraction (LVEF) and 6-minute walking distance (6MWD) from baseline to 24 months after randomization. Results Finally, 138 patients of the ALA group and 139 patients of the placebo group attained the primary outcome. Hospitalization for HF or all-cause mortality events occurred in 32 patients (23.2%) of the ALA group and in 40 patients (28.8%) of the placebo group (HR＝0.753, 95%CI 0.473-1.198, P＝0.231; Figure 1A-1C). The absolute risk reduction (ARR) was 5.6%, the relative risk reduction (RRR) associated with ALA therapy was approximately 19.4% compared to placebo, corresponding to a number needed to treat (NNT) of 18 patients to prevent one event. In the secondary outcome analysis, the composite outcome of the major adverse cardiovascular events (MACE) including the hospitalization for HF, all-cause mortality events, non-fatal MI or non-fatal stroke occurred in 35 patients (25.4%) in the ALA group and 47 patients (33.8%) in the placebo group (HR＝0.685, 95%CI 0.442-1.062, P＝0.091; Figure 1D). Moreover, greater improvement in LVEF (β＝3.20, 95%CI 1.14-5.23, P＝0.002) and 6MWD (β＝31.7, 95%CI 8.3-54.7, P＝0.008) from baseline to 24 months after randomization were observed in the ALA group as compared to the placebo group. There were no differences in adverse events between the study groups. Conclusions These results show potential long-term beneficial effects of adding ALA to IHF patients. ALA could significantly improve LVEF and 6MWD compared to the placebo group in IHF patients.

Objective To investigate the therapeutic effects of Isaria felina derived from Cordyceps sinensis combined with cyclophosphamide(CTX)in hepatoma H22 tumor-bearing mice.Methods An H22 tumor-bearing mouse model was established and mice were divided randomly into a normal control group(NC group,distilled water),model control group(MC group,distilled water),positive control group(CTX group,25 mg/kg),Isaria felina group(IF group,400 mg/kg),and combined administration group(IF+CTX group,IF 400 mg/kg+CTX 25 mg/kg),with 5 mice in each group.Distilled water and IF were administered by gavage,and CTX was administered by intraperitoneal injection.The administration cycle was 10 days.At the end of the experiment,the mean tumor volume and weight,tumor inhibition rate,q value,and immune organ index were calculated,and routine blood indexes and cytokine levels were determined.Histopathological changes in tumor tissues were observed by HE staining.Results The tumor volume and mass were significantly lower in mice in each treatment group compared with those in mice in the MC group(P＜0.05).The tumor inhibition rates in the CTX,IF,and IF+CTX groups were 49.3%,34.2%,and 72.8%,respectively,and the q value was 1.09.The numbers of white blood cells,Lymph,and platelets were significantly higher in the IF+CTX group than in the CTX group(P＜0.05).The spleen index was significantly higher in the MC group compared with that in the NC group,and significantly lower in the IF+CTX group compared with that in the MC group(P＜0.05).Serum interferon-γ levels were significantly lower in the MC group than in the NC group,and were significantly higher in the IF and IF+CTX groups compared with those in the MC and CTX groups(P＜0.05).Pathologically,tumor cells in the MC group grew well and were numerous and closely arranged,while cells in the CTX,IF,and IF+CTX groups were arranged loosely,with focal necrosis and nuclear pyknosis of necrotic cells in many places.Conclusions The combination of IF and CTX has an additive anti-tumor effect on H22 tumor-bearing mice,which can alleviate immunosuppression and have an immunomodulatory function.

Objective To explore the possible causes of CAST/EiJ mouse susceptibility to multiple pathogens,the immune cell phenotypes in the peripheral blood and spleen of CAST/EiJ mice were analyzed to clarify their composition.Methods Classical dendritic cells(cDCs),natural killer(NK)cells,B lymphocytes,T lymphocytes,and their subsets in the peripheral blood and spleen of CAST/EiJ mice and C57BL/6J mice were detected by flow cytometry using the cell surface markers CD3,CD4,CD8,CD11b,CD11c,CD19,CD27,CD49b,and TCRβ.Results There was no significant difference in the proportion of cDCs between CAST/EiJ and C57BL/6J mice,but the cDC1 cell subset population was smaller in CAST/EiJ.The proportions of NK cells(mainly mature NK cell subsets)and T lymphocytes(mainly CD8+T cells)were both lower in CAST/EiJ mice than C57BL/6J mice,while the proportion of B cells was higher in CAST/EiJ mice than C57BL/6J mice.Conclusions The proportions of NK and T lymphocytes in CAST/EiJ mice were lower than those in C57BL/6J mice.

Objective:To explore the influencing factors of loss of follow-up in a cohort study of participants with acute phase depressive disorders.Methods:A multicenter prospective cohort of patients with depressive disorders conducted from 2017 to 2021 was followed up at baseline, week 4, and week 8.The general information, disease characteristics, life satisfaction, functional status and other information of the subjects were collected.Loss of follow-up was determined by whether the patients followed the follow-up plan for on-site visits.SAS 9.4 software was used for data description and statistical analysis, and multiple Logistic regression analysis was used to explore the influencing factors of subjects loss to follow-up.Results:A total of 1 023 patients with acute phase depressive disorders were included in the study.The scores of the 17-item Hamilton depression rating scale, the quality of life enjoyment and satisfaction questionnaire-short form, and Sheehan disability scale were 18.3±6.6, 37.7±9.6, and 13.8±7.5, respectively.The loss of follow-up ratios at week 4, week 8 and complete visits were 28.6% (293/1 023), 19.5% (199/1 023), and 13.9% (142/1 023), respectively.Multivariate analysis showed that higher depression severity at baseline ( OR=0.81, 95% CI=0.79-0.84) and higher life satisfaction at baseline ( OR=0.96, 95% CI=0.95-0.97) were associated with lower loss of follow-up ratio at week 4.Compared with the < 30-year group, the loss of follow-up ratio at week 4 in the 40-49 -year group was lower ( OR=0.36, 95% CI=0.19-0.65).Patients with high anxiety factor scores ( OR=1.41, 95% CI=1.30-1.54) and the first depressive episode ( OR=1.52, 95% CI=1.10-2.12) had higher loss of follow-up ratio at week 4.The lower loss of follow-up ratio was associated with education level at week 8 ( OR=0.42, 95% CI=0.21-0.85) and life satisfaction at week 4 ( OR=0.97, 95% CI=0.94-0.99).A higher baseline anxiety levels ( OR=1.38, 95% CI=1.27-1.50), lower severity of baseline depressive symptoms ( OR=0.83, 95% CI=0.80-0.86), younger age ( OR=0.44, 95% CI=0.25-0.75), and lower baseline life satisfaction ( OR=0.96, 95% CI=0.95-0.97) were associated with a higher risk of complete loss of follow-up.There was a significant association between the research center and the loss of follow-up rate at week 4, 8, and complete visits. Conclusions:Patients with first episode depression in the acute phase, younger onset age, lower depression severity, comorbid anxiety symptom, and poor or no improvement in disease-related quality of life/satisfaction were associated with a higher risk of loss of follow-up in the prospective cohort study.

High quality continuing medical education is important to ensure the clinical competence of doctors. However, the current continuing medical education of general practitioners has some problems, such as low motivation to participate in and poor training effect. We tried a new model of continuing medical education to deal with these problems. In this new model, position competence improvement is the aim, online group learning is the main method, individualized learning goals are developed and results are evaluated in verifiable ways.

Objective:To identify the risk factors and to construct a predictive model for early postnatal mortality (with the first 7 days of life) in extremely preterm infants.Methods:This retrospective study involved 244 extremely preterm infants with a gestational age of 22 to 27 weeks and 6 days, born at the Affiliated Hospital of Jining Medical College from January 2017 to December 2022. They were divided into an early survival group ( n=140) and an early mortality group ( n=84), based on survival for ≥7 days after birth. LASSO and logistic regression were used to select risk factors for early mortality. A nomogram predictive model was constructed using the R software program. The goodness-of-fit tests, area under the curve (AUC), calibration curves, and decision curves were used to evaluate its performance and clinical usefulness. Results:LASSO regression and multivariate logistic regression analyses showed that breech delivery ( OR=3.055, 95% CI: 1.125-8.296), intubation in the delivery room ( OR=4.320, 95% CI: 1.328-14.053), diagnosis of grade Ⅲ-Ⅳ neonatal respiratory distress syndrome within 6 h after birth ( OR=11.552, 95% CI: 3.056-43.677), and use of adrenaline in the delivery room ( OR=10.706, 95% CI: 1.454-78.816) were risk factors for early mortality in extremely preterm infants. Conversely, large gestation age ( OR=0.234, 95% CI: 0.125-0.436), antenatal administration of corticosteroids to promote fetal lung maturity ( OR=0.046, 95% CI: 0.014-0.145), and the use of pulmonary surfactant within 6 h after birth ( OR=0.021, 95% CI: 0.004-0.122) were protective factors against mortality. The goodness of fit test of the early death risk nomogram prediction model for extremely preterm infants indicates a good fit ( P=0.702). The AUC of the model was 0.963 (95% CI: 0.943-0.983), with a sensitivity of 0.904 (95% CI: 0.806-0.949), specificity of 0.892 (95% CI: 0.829-0.938), and accuracy of 0.880. Decision curve analysis indicated that a threshold probability>2% would yield a net benefit. Conclusions:Breech delivery, intubation in the delivery room, use of adrenaline in the delivery room, and the diagnosis of grade Ⅲ-Ⅳ neonatal respiratory distress syndrome within 6 h post-birth are independent risk factors for early mortality in extremely preterm infants. Large gestational age, antenatal administration of corticosteroids to promote fetal lung maturity and use of pulmonary surfactant within 6 h after birth are protective factors. The constructed prediction model based on the aforementioned factors can quantitatively, conveniently, and intuitively assess the risk of early mortality in extremely preterm infants.

Objective:To explore the application effect of multi-sensory stimulation with breastmilk in preterm infants with venipuncture pain, so as to provide theoretical guidance for clinical implementation of neonatal pain management.Methods:This study was a randomised controlled trial that selected 90 cases of preterm infants who were admitted to the Department of Neonatal Internal Medicine of Shanxi Children′s Hospital from May to October 2023, and were randomly divided into the control group and the intervention group, with 45 cases in each group. The control group received routine neonatal analgesia based on preparation before intervention, and the intervention group received multi-sensory stimulation with breastmilk based on preparation before intervention. Premature Infant Pain Profile-Revised(PIPP-R), The Chinese COMFORTneo Scale and physiological stress indicators (heart rate and oxygen saturation) were used to compare the pain level, comfort level and physiological stress response of preterm infants in the two groups 3 min before, during and 1 to 5 min after the venipuncture operation.Results:Finally, 80 cases of preterm infants were included with 40 cases in each group. The control group was born at a gestational age of (34.61 ± 1.16) weeks, with 19 males and 21 females; the intervention group was born at a gestational age of (34.74 ± 1.16) weeks, with 22 males and 18 females. Comparison between the groups showed that during and 5 min after the operation, the PIPP-R scale scores of the intervention group were (6.83 ± 0.26), (0.80 ± 0.25) points, respectively, which were lower than those of the control group (12.25 ± 0.70), (2.83 ± 0.36) points, and the differences were statistically significant (Wald χ2=53.31, 21.43, both P<0.01).The Chinese COMFORTneo Scale scores of the intervention group were (14.15 ± 0.64), (6.45 ± 0.13) points, which were lower than those of the control group (20.87 ± 0.82), (8.20 ± 0.32) points, and the differences were statistically significant (Wald χ2=41.89 and 25.75, both P<0.01); the heart rate of the intervention group were (161.07 ± 1.09), (142.48 ± 0.99) beats/min, which were lower than those of the control group(169.30 ± 1.93), (147.23 ± 2.15) beats/min, and the differences were statistically significant (Wald χ2=13.83, 4.03, both P<0.05). During the operation to 2 min after the operation, the blood oxygen saturation of the intervention group were 0.950 3 ± 0.004 0, 0.959 3 ± 0.003 4, 0.9663 ± 0.003 0, respectively, which were higher than those of the control group 0.925 3 ± 0.003 6, 0.940 5 ± 0.003 6, 0.9500 ± 0.004 3, and the differences were statistically significant (Wald χ2=21.98, 14.62, 9.70, all P<0.05). Conclusions:Multi-sensory stimulation with breastmilk can reduce the pain degree in preterm infants, improve the comfort level of preterm infants, reduce the physiological stress response and promote physiological stability of preterm infants during and after the operation of venipuncture.

Objective To explore the characteristics of TCM prescriptions for acute gouty arthritis based on data mining methods;To provide reference for clinical treatment.Methods The clinical literature on the TCM treatment of acute gouty arthritis was retrieved from CNKI,Wanfang Data,VIP and SinoMed.The obtained formulas were input into Excel 2019 to establish a database,and SPSS Modeler 18.0,SPSS Statistics 26.0 and Cytoscape 3.9.1 were used for frequency analysis,association rule analysis,clustering analysis and factor analysis.Results A total of 290 articles meeting the requirements were included,including 295 prescriptions,involving 218 kinds of Chinese materia medica,with a total frequency of 3 573 times.24 kinds of Chinese materia medica,including Coicis Semen,Phellodendri Chinensis Cortex,Atractylodis Rhizoma,Smilacis Glabrae Rhizoma,Dioscoreae Spongiosae Rhizoma,Glycyrrhizae Radix et Rhizoma,Achyranthis Bidentatae Radix were used frequently in the treatment of acute gouty arthritis.The commonly used drugs were heat-clearing drugs,moisture-clearing drugs,blood circulation-activating drugs for removing blood stasis,and wind-dampness drugs.The property was mainly cold,the taste was mainly bitter,and the meridians were mainly liver,stomach,spleen and kidney meridians.The analysis of high-frequency drug association rules obtained 22 drug combinations,among which the core drug pairs were Phellodendri Chinensis Cortex-Atractylodis Rhizoma,Coicis Semen-Atractylodis Rhizoma-Phellodendri Chinensis Cortex.Clustering analysis obtained 4 clustering methods,and factor analysis obtained 9 common factors.Conclusion The main treatment of acute gouty arthritis by TCM is clearing heat and dampness,removing blood stasis and clearing collaterals,tonifying liver and kidney,regulating spleen and stomach,which could provide reference for the clinical treatment of acute gouty arthritis.

Objective To analyze the short-term survival and prognostic quality of life of patients with liver cirrhosis complicated by bacterial infection. Methods This study collected and analyzed 300 patients with liver cirrhosis complicated with infection who were hospitalized in the First Affiliated Hospital of Hebei North University, and followed up to discuss their survival and quality of life. Results In this study, the top two causes of infection were spontaneous bacterial peritonitis (60.67% of patients) and pneumonia (50.67% of patients). The second causes were urinary tract infections (15.33%), gastrointestinal infections (12.33%), and other causes. There was no statistically significant difference between male and female patients (P>0.05). In addition, the proportion of hospital infections was 71.00%, and there was no statistically significant difference between male and female patients (P>0.05). A total of 353 strains of pathogenic bacteria were isolated in this study (73.37% of patients with hospital infections). The distribution analysis of pathogenic bacteria showed that the highest proportion of ECO was 35.98%, followed by Klebsiella pneumoniae (18.98%). The distribution trend of 259 strains of pathogenic bacteria among hospital patients was consistent with that of all strains, and the difference was not statistically significant (P>0.05). Gram negative bacteria accounted for 79.60% (281/353) of all detected strains, of which Escherichia coli was mostly detected in patients with spontaneous bacterial peritonitis, Klebsiella Pneumoniae (KPN) and Pseudomonas aeruginosa (PAE) were mostly detected in patients with pneumonia, and Enterococcus (ENF) was mostly detected in patients with urinary tract infection; Among gram-negative bacteria, Staphylococcus epidermidis (SEP) and Staphylococcus aureus (SAU) are mostly found in patients with other infectious causes (blood flow infection, etc.) , and Streptococcus (STR) accounts for a high proportion in patients with Spontaneous bacterial peritonitis. In this study, 9 cases of death prognosis were detected during follow-up, and there was no statistically significant difference in the detection of death prognosis between different bacterial strains in both genders, as well as the difference in detection of death prognosis between hospital infections and out of hospital infections in both genders (P>0.05). There was no statistically significant difference in the detection of death prognosis between males and females due to different causes of infection, P>0.05. The quality of life scores of 291 surviving patients were compared between baseline and follow-up, indicating an increase in follow-up scores, especially in the dimensions of physiological function and physical pain. There was no statistically significant difference between different bacterial strains, infection causes, and hospital/non hospital infections (P>0.05) . Conclusion Spontaneous bacterial peritonitis and pneumonia are the main causes of infection that deserve special attention, and the main pathogens of infection are Gram negative bacteria. Targeted treatment and rehabilitation should be provided for patients with liver cirrhosis complicated by infection. At the same time, the proportion of hospital infections is relatively high, and attention should be paid to, prevention and control measures should be implemented as well.