Objective To analyze the problems in the operation and management of drug clinical trials and put forward targeted suggestion. Methods An electronic questionnaire survey was conducted among medical staff in about 80 hospitals in the yangtze river delta region. Results 606 valid questionnaires were received. 71% of the respondents expressed their willingness to study and participate in drug clinical trials. There were significant differences in the cognitive demands, willingness and motivation of the respondents with different occupations and educational backgrounds about the drug clinical trial work （P<0.05）. During the operation of drug clinical trials, respondents reported the main factors affecting the quality of clinical trials which including good clinical practice (GCP) awareness and subjective enthusiasm of investigators （response rate 27%）, job stability of supervisors and research coordinators （27%）, compliance of subjects （45%）, quality control of the whole process of the circulation of test drugs, medical devices and biological samples （52%）, and the informatization level of clinical trial institutions （30%）. Conclusion Hospitals, institutions and project teams could take measures to cultivate and stabilize the drug clinical trial talent team, improve the quality management system of drug clinical trials, improve work efficiency, and promote the high-quality development of drug clinical trials in medical institutions.

ObjectiveTo systematically evaluate the application of narrative education in undergraduate nursing teaching， to understand the current application status of narrative education， and to provide a theoretical basis for the subsequent establishment of a sound narrative education system. MethodsA systematic search was conducted for studies published in Chinese and English databases on applying narrative education to undergraduate nursing teaching， with the search period ranging from database inception to February 23， 2025. Literature was screened， and relevant information was extracted. A rigorous quality evaluation was conducted on the included studies， and a descriptive analysis was performed on their content. ResultsA total of 20 papers were included， involving 3，180 research subjects， all of whom were undergraduate nursing students. The results of descriptive analysis showed that the teaching model of narrative education primarily encompassed reading narrative works， watching films and videos， performing narrative scenarios， and writing reflective journals. The course setting and content covered pre-teaching preparation and in-teaching implementation. The evaluation of teaching effectiveness included the evaluation of teachers’ teaching methods （student evaluation/self-evaluation） and the evaluation of students’ learning effectiveness （course grade evaluation/humanistic care scale/empathy scale assessment， and others）. ConclusionNarrative education combines abstract concepts with concrete clinical situations， which not only enriches students’ learning experiences but also enhances their humanistic literacy. Meanwhile， it provides teachers with opportunities to develop their narrative teaching skills， which requires them to possess profound professional knowledge and employ narrative techniques to guide students in reflection and critical thinking， thereby improving teaching quality and learning outcomes. Future efforts should consistently deepen the connotation research of narrative education and build a systematic nursing education system.

OBJECTIVE To establish a content determination method for two specific C21‑steroid saponins namely 3- O - β -allopyranosyl-（1→4）- β -oleandropyranosyl-11- O -isobutyryl-12- O -acetyl tenacigenin B（compound T） and 17 β -tenacigenin B in Marsdenia tenacissima decoction pieces.METHODS Ultra‑high‑performance liquid chromatography‑tandem mass spectrometry （UPLC‑MS/MS） was adopted. An XSelect HSS T3 XP chromatographic column was used. Gradient elution was performed with 0.1% formic acid aqueous solution-methanol as the mobile phase. The flow rate was 0.3 mL/min， the injection volume was 5 μL， and the column temperature was 40 ℃. An electrospray ionization source was applied for mass spectrometry， and multiple reaction monitoring mode was used for positive‑ and negative‑ion acquisition.RESULTS The linear relationships of compound T and 17 β -tenacigenin B were good within the concentration ranges of 10-200 ng/mL and 20-200 ng/mL， with r values of 0.993 1 and 0.998 6， respectively； the RSD values of precision， repeatability， accuracy， and stability were all below 4.5% （ n ＝5-6）. Their contents in three batches of decoction pieces were 94.0-102.8 μg/g and 1 705.4-1 736.2 μg/g， respectively.CONCLUSIONS The established method can be applied for the content determination of the two specific C21‑steroid saponins mentioned above in M. tenacissima decoction pieces.

ObjectiveTo investigate and analyze an outbreak of rotavirus infectious diarrhea in a prison in Chongqing Municipality, to provide a basis for adult rotavirus surveillance and prevention, and to explore the public health problems in special settings. MethodsA retrospective survey was conducted to collect and analyze data on individual cases with diarrheal disease on-site. The clinical characteristics, as well as the temporal, spatial and geographical distribution patterns of the epidemic were described. Multi-pathogen detection tests were conducted both on diarrhea cases and environmental samples, with viral genotyping performed on positive samples. A case-control analysis was performed to identify the causes of the outbreak, and an SEIR model was adopted to predict the outbreak trend and evaluate the effectiveness of interventions. ResultsA total of 65 cases were found among the inmates, with an attack rate of 2.03%. The predominant clinical manifestations included diarrhea (89.23%), watery stool (73.85%), and dehydration (18.46%). The epidemic curve indicated a “human-to-human” transmission pattern, with an average incubation period of 5‒6 days. The attack rates among chefs in the main canteen (80.00%, 8/10) and caterers (28.33%, 17/60) were significantly higher than those of other inmates （P<0.05）. Multi-pathogen polymerase chain reaction (PCR) testing detected positive for group A rotavirus, with the viral genotyping identified as G9P [8] strain. Factors such as unprotected "bare-handed" food distribution among cases with diarrhea (OR=9.512, 95%CI: 4.261‒21.234) and close contact with diarrhea cases (OR=3.656, 95%CI: 1.719‒7.778) were the possible cause of the outbreak. The SEIR model (r₀=5, α=0.3, β₁=0.08, β₂=0.04) was constructed using prison inmates as susceptible population, aiming at fitting the initial transmission trend of the outbreak, and the epidemic rate declined rapidly after intervention measures were implemented (r_t≈0). ConclusionThis rare rotavirus infection diarrhea outbreak among adults in confined settings suggests that the construction of public health prevention and control systems in prison may be overlooked. Cross infection during meal processing and distribution in the canteens of such settings is likely to be the cause of the outbreak. Given the potential neglect of public heath system construction in special settings, it is imperative to enhance the surveillance and monitoring of rotavirus and other intestinal multi-pathogens among adults, as well as the construction of public health prevention and control systems in these special settings.

Objective To investigate the spatio-temporal expression of nuclear receptor subfamily 0 group B member 1(NR0B1)in synovial tissues of rheumatoid arthritis(RA),and to uncover the potential upstream signalling pathway that may regulate NR0B1 expression in human fibroblast-like synovial cells,thereby clarifying the possible factors that induce the disorder of NR0B1 expression in RA.Methods Patients with 25 RA and 18 osteoarthritis(OA)who did not receive any immunotherapy were recruited to obtain the synovial tissues of knee joint,as well as their related clinical test information,and the expression characteristics of NR0B1 in synovial tissue were investigated using Real-time PCR,Western blotting,immunohistochemistry and double immunofluorescent staining.Meanwhile,Pearson Chi-square test was used to evaluate the correlation between NR0B1 mRNA expression level and clinical parameters in RA patients.Furthermore,the MH7ANR0B1-/-cells that were stably knocked down of endogenous NR0B1 were generated,and the effects of NR0B1 deficiency on the phenotype of rheumatoid synovial cells enhanced by vascular endothelial growth factor(VEGF)were then evaluated by means of cell viability and apoptosis assays,colony formation assay,wound healing assay,and cell invasion assay.Last,we studied the molecular mechanism underlying interleuikin 6(IL-6)-mediated regulation of NR0B1 expression at the transcriptional level by using the STAT3-specific inhibitor intervention,siRNA,and dual luciferase reporter gene detection.Results The expression level of NR0B1 mRNA in the RA synovial tissues was significantly higher than that in synovial tissues from OA patients(P＜0.05).This trend of the increased NR0B1 mRNA expression correlated to clinical parameters,including C-reactive protein(CRP),rheumatoid factor(RF)and erythrocyte sedimentation rate(ESR),in RA patients.NR0B1 protein was predominantly immunolocalized in fibroblast-like synoviocytes of RA synovial tissues.Functionally,knockdown of NR0B1 expression markedly neutralize the VEGF-mediated enhancement of cell viability,resistance to apoptosis,clonogenicity,as well as migration and invasion in the MH7A cells.Additionally,IL-6 could specifically regulate NR0B1 expression in the MH7A synovial cells.IL-6 upregulated the transcriptional expression of NR0B1 mainly through induction of the phosphorylation of its downstream STAT3 at the Tyr-705 site.Conclusion The upregulated NR0B1 expression in fibroblast-like synoviocytes is positively correlated with the progression of RA.The proinflammatory cytokine IL-6 potentiates the transactivation of NR0B1 by inducing the phosphorylation of Tyr-705 site of its downstream effector STAT3.NR0B1 may be a significant breakthrough point for understanding the interaction between IL-6 and VEGF signaling pathways and the progression of RA.

OBJECTIVE: Exposure to polycyclic aromatic hydrocarbons (PAHs) or metal(loid)s individually has been associated with neural tube defects (NTDs). However, the impacts of PAH and metal(loid) co-exposure and potential interaction effects on NTD risk remain unclear. We conducted a case-control study in China among population with a high prevalence of NTDs to investigate the combined effects of PAH and metal(loid) exposures on the risk of NTD. METHODS: Cases included 80 women who gave birth to offspring with NTDs, whereas controls were 50 women who delivered infants with no congenital malformations. We analyzed the levels of placental PAHs using gas chromatography and mass spectrometry, PAH-DNA adducts with ³²P-post-labeling method, and metal(loid)s with an inductively coupled plasma mass spectrometer. Unconditional logistic regression was employed to estimate the associations between individual exposures and NTDs. Least absolute shrinkage and selection operator (LASSO) penalized regression models were used to select a subset of exposures, while additive interaction models were used to identify interaction effects. RESULTS: In the single-exposure models, we found that eight PAHs, PAH-DNA adducts, and 28 metal(loid)s were associated with NTDs. Pyrene, selenium, molybdenum, cadmium, uranium, and rubidium were selected through LASSO regression and were statistically associated with NTDs in the multiple-exposure models. Women with high levels of pyrene and molybdenum or pyrene and selenium exhibited significantly increased risk of having offspring with NTDs, indicating that these combinations may have synergistic effects on the risk of NTDs. CONCLUSION Our findings suggest that individual PAHs and metal(loid)s, as well as their interactions, may be associated with the risk of NTDs, which warrants further investigation.
Humans ; Neural Tube Defects/chemically induced* ; Polycyclic Aromatic Hydrocarbons/adverse effects* ; Female ; Case-Control Studies ; China/epidemiology* ; Adult ; Pregnancy ; Environmental Pollutants ; Maternal Exposure/adverse effects* ; Metals/toxicity* ; Young Adult ; Risk Factors

Objective:To observe the clinical efficacy of against-lateral correction Tuina(Chinese therapeutic massage)in treating atlanto-axial joint disorder(AAJD)and imaging changes.Methods:A total of 142 patients with AAJD were recruited.They were randomly allocated to a trial group and a control group using the random number table method,with 71 participants in each group.The trial group was treated with against-lateral correction Tuina 3 times weekly.The control group was offered conventional physical traction therapy once daily.The interventions lasted 2 weeks in both groups.The two groups of participants were observed before and after treatment for their changes in the global pain scale(GPS)score,visual analog scale(VAS)score for dizziness assessment,cervical range of motion(ROM)in rotation,and the extent of atlanto-dental displacement.Results:The GPS and VAS scores dropped after treatment in both groups(P<0.05)and were lower in the trial group than in the control group after treatment and at the follow-up(P<0.05).Participants in the trial group achieved a significant increase in the cervical ROM in rotation after treatment and at the follow-up compared to the pre-treatment value(P<0.05)and surpassed the control group(P<0.05);the control group only showed an increase in the left-side rotation(P<0.05).After the intervention,neither the intra-group nor the between-group comparison revealed significant differences in the extent of atlanto-dental displacement(P>0.05),though the trial group presented an improving tendency.Conclusion:Compared to physical traction,the against-lateral correction Tuina method works more significantly in improving pain,dizziness,and ROM in AAJD patients.

Objective:To evaluate the safety and feasibility of radical hepatectomy after conversion therapy in patients with initially unresectable advanced hepatocellular carcinoma (HCC).Methods:Clinical data of 72 patients with initially unresectable advanced HCC admitted to the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University and the Department of Hepatobi-liary and Pancreatic Surgery, Henan Provincial People's Hospital from January 2020 to July 2024 were retrospectively collected, including 61 males and 11 females, aged (58.4±9.1) years. The clinicopathological data of the patients, such as tumor characteristics, conversion treatment regimens, perioperative data, and follow-up situations were analyzed to evaluate the therapeutic effect and safety.Results:Among the patients, there were five cases of China liver cancer staging Ⅰb, six cases of Ⅱa, 22 cases of Ⅱb, 32 cases of Ⅲa and sevene cases of Ⅲb. There were 53 patients scored as Child-Pugh A and 19 as Child-Pugh B. Conversion treatment fashion included immunotherapy combined with targeted therapy and immunotherapy plus targeted therapy combined with hepatic arterial chemoembolization or hepatic arteryinfusion chemotherapy. Liver resection after conversion therapy was as follows: 16 cases of right hemihepatectomy, 20 cases of left hemihepatectomy, 11 cases of mesohepatectomy, seven cases of right posterior hepatectomy, 1 case of caudate lobectomy, 17 cases of local resection. Postoperative pathology showed that there were 17 cases of pathologic complete response and 55 cases of pathologic partial response. One patient died of liver failure after surgery, while the rest had no major complications. The postoperative hospital stay was (13.1±5.1) d. The follow-up time was 21.5(10.2, 32.1) months. The multivariate Cox analysis demonstrated that pathologic partial response and adjuvant therapy duration shorter than 5 cycles were identified as independent risk factors-affecting both recurrence-free survival and overall survival in patients with HCC undergoing sequential surgery after conversion therapy (all P<0.05). Conclusion:Sequential surgical resection provides survival benefits for patients with initially unresectable and advanced HCC after conversion therapy, which is a safe and effective therapeutic strategy.

Sepsis was redefined in 2016 by the updated Sepsis 3.0 criteria as a life-threatening organ dysfunction caused by dysregulated immune response to infection. This revision introduced the sequential organ failure assessment (SOFA) score as one of the key diagnostic criteria, making the diagnosis of sepsis more precise and clinically applicable. Despite significant advancements in the diagnosis and treatment of sepsis, its high incidence, mortality rate, and healthcare costs remain major global public health challenges. The core pathogenesis of sepsis involves severe dysregulation of the host immune response, which further leads to tissue damage and multiple organ dysfunction. Therefore, in-depth research into the immune response mechanisms of sepsis is crucial for optimizing clinical treatment strategies. This article systematically summarizes the characteristics of pathogenic microorganisms in sepsis, its pathogenesis, immune features at various stages, and the challenges faced in clinical treatment. It also explores the potential value of precision medicine in the clinical diagnosis and treatment of sepsis, aiming to provide references for addressing key issues in multidrug resistance and immune mechanism research in sepsis.

Laparoscopic subtotal cholecystectomy (LSC) has been a safe and viable alternative to conversion to laparotomy in cases of severe cholecystitis. The objective of this study is to determine the utility of intraoperative choledochoscopy in LSC for the exploration of the gallbladder, cyst duct, and subsequent stone clearance of the cystic duct in cases of severe cholecystitis. A total of 72 patients diagnosed with severe cholecystitis received choledochoscopy-assisted laparoscopic subtotal cholecystectomy (CALSC). A choledochoscopy was performed to explore the gallbladder cavity and/or cystic duct, and to extract stones using a range of techniques. The clinical records, including the operative records and outcomes, were subjected to analysis. No LSC was converted to open surgery, and no bile duct or vascular injuries were sustained. All stones within the cystic duct were removed by a combination of techniques, including high-frequency needle knife electrotomy, basket, and electrohydraulic lithotripsy. A follow-up examination revealed the absence of residual bile duct stones, with the exception of one common bile duct stone, which was extracted via endoscopic retrograde cholangiopancreatography. In certain special cases, CALSC may prove to be an efficacious treatment for the management of severe cholecystitis. This technique allows for optimal comprehension of the situation within the gallbladder cavity and cystic duct, facilitating the removal of stones from the cystic duct and reducing the residue of the non-functional gallbladder remnant.