ObjectiveThis paper aims to investigate and evaluate the staged efficacy and safety of the representative empirical prescription of the “Zhu Ke Jiao” theory， Qijia Rougan prescription， combined with entecavir in the treatment of hepatic fibrosis in chronic hepatitis B. MethodsA multicenter randomized controlled clinical study was conducted， and 101 patients diagnosed with chronic hepatitis B-related hepatic fibrosis （CHB-HF） who met the diagnosis and inclusion criteria were randomly assigned to an observation group （Qijia Rougan prescription + entecavir） and a control group （entecavir）. The treatment duration was 24 weeks. Liver stiffness measurement （LSM）， fibrosis-4 index （FIB-4）， portal vein diameter， hepatitis B serology， biochemical indicators， hepatic fibrosis markers in serum ［hyaluronic acid （HA）， laminin （LN）， procollagen Ⅲ peptide （PⅢP）， and type Ⅳ collagen （Ⅳ-C）］， and traditional Chinese medicine syndrome scores were used as efficacy evaluation indicators. Efficacy assessments and explorations of different staged subgroups of Qijia Rougan prescription were conducted according to LSM values based on the Metavir pathological staging standard. ResultsA total of 98 cases were included for statistical analysis， with 49 cases in the observation group and 49 in the control group. The general data of the patients in both groups were comparable. Compared with the same group before treatment， the observation group showed a significant reduction in LSM and FIB-4 （P<0.01）， as well as notable improvements in LN， Ⅳ-C， and various TCM syndrome scores （P<0.05， P<0.01）. When compared to the control group after treatment， the observation group demonstrated significant improvements in LSM， FIB-4， and various TCM syndrome score indicators （P<0.05， P<0.01）， indicating that the observation group performed better than the control group. Subgroup analysis of the regression of hepatic fibrosis stages showed that compared to the same group before treatment， the observation group had better improvement in regression of stages F2 and F3 （P<0.05）. When compared to the control group after treatment， the observation group exhibited superior improvement in regression of stage F3 （P<0.05）. No adverse events occurred in either group during the treatment period. ConclusionCompared with entecavir alone， the combination of Qijia Rougan prescription and entecavir significantly improves the degree of hepatic fibrosis and clinical TCM symptoms in patients. The optimal intervention period is primarily during stage F3， which is a potential “interception” point of the “Zhu Ke Jiao” theory.

OBJECTIVE To study the protective effect and potential mechanism of chikusetsu saponin Ⅳ a （chsⅣ） on renal function in diabetic nephropathy （DN） model rats. METHODS DN rat model was established by high-fat diet combined with streptozotocin injection. Thirty-six model rats were randomly divided into model group （i.g. administration of normal saline， high-fat diet）， chsⅣ low-dose and high-dose groups （i.g. administration of 90， 180 mg/kg chsⅣ， high-fat diet）， with 12 rats in each group. Additionally， 10 normal rats were set as the control group （i.g. administration of normal saline， regular diet）. From the 5th to the 12th week after streptozotocin injection， they were given intragastric administration of relevant drug or normal saline， once a day. After the last medication， the levels of fasting blood glucose， fasting insulin， blood urea nitrogen， serum creatinine and urine protein as well as the levels of reduced glutathione （GSH）， superoxide dismutase （SOD） and malondialdehyde （MDA） in renal tissues were measured. Additionally， the insulin resistance index was calculated. Hematoxylin-eosin， periodic acid-Schiff， and Masson staining techniques were employed to examine the histopathological alterations in the renal tissue. The expressions of Notch signaling pathway-related proteins in renal tissue were detected by immunohistochemical staining and Western blot methods. RESULTS Compared with model group， the histomorphological of renal tissues in the chsⅣ low- and high-dose groups were significantly improved， with significant decreases in renal histological scores， mesangial expansion index， and glomerulosclerosis scores （ P ＜0.05）； the levels of fasting blood glucose， fasting insulin， blood urea nitrogen， serum creatinine， urine protein and homeostasis model assessment for insulin resistance， as well as MDA content， the expression levels of Notch1， Notch intracellular domain， hairy and enhancer of Split 1 and Delta-like protein 1 in renal tissue were all significantly decreased （ P ＜0.05）. The levels of GSH and SOD in renal tissue were significantly elevated （ P ＜0.05）. Moreover， the improvement in these indicators was significantly more pronounced in the chsⅣ high-dose group compared to the chsⅣ low-dose group （ P ＜0.05）. CONCLUSIONS ChsⅣ can ameliorate renal pathological damage and functional impairment in DN rats. Its underlying mechanisms include restoration of glucose homeostasis and insulin sensitivity， attenuation of renal oxidative stress， and suppression of aberrant Notch signaling pathway activation.

ObjectiveThis paper aims to explore the risk factors for chronic atrophic gastritis （CAG） with turbidity toxin accumulation syndrome and establish a prediction model. MethodsClinical data of 180 patients with CAG who participated in the "clinical study of Xianglian Huazhuo Particles blocking CAG cancer transformation" of Hebei Sheng Zhong Yi Yuan from July 2021 to March 2022 were collected. After confounding factors were controlled by propensity score matching， patients were divided into a training set （namely dev） and a validation set （namely vad） in a seven to three ratio. The risk factors for CAG with turbidity toxin accumulation syndrome in the training set were investigated by using univariate Logistic regression analysis and least absolute shrinkage and selection operator （namely Lasso） regression algorithms. Subsequently， a model， named model 1se， was developed by using the training set data to predict the risk factors for CAG with turbidity toxin accumulation syndrome. The accuracy of the prediction model was assessed by using various methods， including the receiver operating characteristic （ROC） curve， Hosmer-Lemeshow test （H-L）， calibration plot， and decision curve analysis （DCA）. ResultsAge， body mass index （BMI）， family history of cancer， job and life satisfaction， yellow and greasy fur with slippery pulse， and heavy body sensation were independent risk factors of the model. The prediction model showed excellent predictive value for both the training and validation sets. ConclusionThe established prediction model for CAG with turbidity toxin accumulation syndrome has high discrimination and excellent calibration， which could provide an excellent clinical basis for disease diagnosis and individualized treatment of patients.

ObjectiveThis paper aims to explore the risk factors for chronic atrophic gastritis （CAG） with turbidity toxin accumulation syndrome and establish a prediction model. MethodsClinical data of 180 patients with CAG who participated in the "clinical study of Xianglian Huazhuo Particles blocking CAG cancer transformation" of Hebei Sheng Zhong Yi Yuan from July 2021 to March 2022 were collected. After confounding factors were controlled by propensity score matching， patients were divided into a training set （namely dev） and a validation set （namely vad） in a seven to three ratio. The risk factors for CAG with turbidity toxin accumulation syndrome in the training set were investigated by using univariate Logistic regression analysis and least absolute shrinkage and selection operator （namely Lasso） regression algorithms. Subsequently， a model， named model 1se， was developed by using the training set data to predict the risk factors for CAG with turbidity toxin accumulation syndrome. The accuracy of the prediction model was assessed by using various methods， including the receiver operating characteristic （ROC） curve， Hosmer-Lemeshow test （H-L）， calibration plot， and decision curve analysis （DCA）. ResultsAge， body mass index （BMI）， family history of cancer， job and life satisfaction， yellow and greasy fur with slippery pulse， and heavy body sensation were independent risk factors of the model. The prediction model showed excellent predictive value for both the training and validation sets. ConclusionThe established prediction model for CAG with turbidity toxin accumulation syndrome has high discrimination and excellent calibration， which could provide an excellent clinical basis for disease diagnosis and individualized treatment of patients.

Objective To investigate the predictive value of multimodal magnetic resonance imaging(MRI)in the progression of transient ischemic attack(TIA)patients.Methods A retrospective study was conducted on 103 TIA patients admitted to the First Affiliated Hospital of Kangda College,Nanjing Medical University(Lianyungang First People's Hospital)from September 2021 to December 2023.These patients were divided into the TIA group(34 cases)and the ACI group(69 cases)based on whether they progressed to acute cerebral infarction(ACI).All patients underwent multimodal magnetic resonance examinations after admission.The imaging results of the cranial T1WI,T2WI,DWI,TOF-MRA,high-resolution magnetic resonance imaging,and magnetic resonance imaging perfusion-weighted imaging[plaque burden,stenosis degree,enhancement index,pial collateral grading,cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and time to peak(TTP)]were compared between the two groups.The correlation between multimodal MRI findings and ACI risk,as well as their predictive value for ACI,were analyzed.Additionally,multimodal MRI results were compared among patients with different degrees of neurological deficits and different prognoses.Results The ACI group exhibited higher plaque load,stenosis degree,enhancement index,MTT and TTP,worse pIA collateral grade,and lower CBF and CBV compared to the TIA group(P<0.05).Logistic regression analysis revealed that plaque burden,stenosis degree,enhancement index,MTT,and TTP were associated risk factors for disease progression in TIA patients(OR value>1,P<0.001),while pial collateral grade,CBF,and CBV were associated protective factors for disease progression in TIA patients(OR value<1,P<0.001).ROC curve showed that the AUC of ACI predicted by combination of plaque load,stenosis degree,enhancement index,MTT,TTP,pia collateral grade,CBF and CBV was 0.914(95%CI:0.842～0.960),which was greater than that of pia collateral grade alone(Z=0.314,P<0.05).Bootstrap internal validation showed that the joint prediction results were well aligned with the ideal curve,indicating that the predicted incidence of ACI was consistent with the actual incidence.The plaque load,stenosis degree,enhancement index,MTT and TTP of patients with severe neurological deficits were higher than those with mild to moderate deficits,and CBF and CBV were lower than those of mild to moderate patients(P<0.05).The plaque load,stenosis degree,enhancement index,MTT and TTP of patients with poor prognosis were highe,and CBF and CBV were lower than those of with good prognosis(P<0.05).Conclusion Multimodal MRI has certain predictive value for the disease progression in TIA patients,providing a reference for clinical assessment of the condition and prognosis prediction,and helping to formulate targeted follow-up intervention plans.

Objective:To investigate the application value of changes in T/QRS ratio (?T/QRS) in predicting risk stratification for high-risk non-ST-elevation myocardial infarction (NSTEMI).Methods:A total of 158 patients with NSTEMI who received treatment at the Department of Cardiology, Baoji High-tech Hospital, from February 2022 to February 2024 were included in this study. Based on the global registry of acute coronary events score, the enrolled patients with NSTEMI were divided into low-, medium-, and high-risk groups. Baseline data and clinical examination results were collected for all patients, and the clinical outcomes of patients with NSTEMI in different risk stratification groups were compared and analyzed. Spearman correlation analysis was performed to assess the correlation between ?T/QRS and the global registry of acute coronary events score in patients with NSTEMI. Logistic regression analysis was conducted to identify risk factors that influence the severity of NSTEMI. The predictive value of ?T/QRS for high-risk NSTEMI in patients was evaluated using the receiver operating characteristic curve.Results:In patients with NSTEMI from the low-risk, medium-risk, and high-risk groups, the values of ?T/QRS in the inferior and lateral leads increased sequentially [(1.01 ± 0.25) vs. (1.32 ± 0.19) vs. (1.74 ± 0.21), F = 6.10, P < 0.001; (1.01 ± 0.13) vs. (1.36 ± 0.11) vs. (1.66 ± 0.05), F = 5.73, P < 0.001]. Spearman correlation analysis demonstrated a positive correlation between ?T/QRS in the inferior and lateral leads and the global registry of acute coronary events score in patients with NSTEMI ( r = 0.73, P < 0.001; r = 0.78, P < 0.001). Logistic regression analysis revealed that elevated ?T/QRS values in the inferior and lateral leads were risk factors for high-risk NSTEMI, with odds ratios of 10.361 and 10.738, respectively. Receiver operating characteristic curve analysis indicated that the area under the curve for predicting high-risk NSTEMI patients using ?T/QRS in the inferior and lateral leads was 0.932 and 0.855, respectively. Conclusions:?T/QRS in the inferior and lateral leads are associated with risk stratification in patients with NSTEMI and can effectively predict high-risk NSTEMI, suggesting a promising clinical application.

Objective:To investigate the relationship between macrophage activation related factors and clini-cal symptoms of schizophrenia(SCZ).Methods:Outpatient or inpatient SCZ patients(n=166)and normal con-trols(n=71)meeting the diagnostic criteria of DSM 4th edition were selected as subjects.The psychopathological symptoms were assessed by the Positive and Negative Syndrome Scale(PANSS),and the concentrations of α-Na-Galases,MAF and IL-18 were determined by enzyme-linked immunosorbent assay(ELISA).The correlation be-tween biological indicators and clinical symptoms was analyzed and the mediation effect was tested.Results:The concentrations of α-NaGalases(P＜0.001)and MAF(P＜0.01)in SCZ group were lower than those in normal control group.In SCZ group,IL-18 was negatively correlated with α-NaGalases concentration(r=-0.24,P＜0.01).α-NaGalases was positively correlated with MAF concentration(r=0.67,P＜0.001),and the total score of PANSS positive symptom scale was positively correlated with IL-18(r=0.21,P＜0.05)and MAF concentration(r=0.22,P＜0.01).The mediating effect of α-NaGalases and MAF was statistically significant,and the relative mediating effect accounted for 25.47％.Conclusion:The increase of IL-18 level may indicate the occurrence of positive symptoms of schizophrenia,and α-NaGalases and MAF may negatively regulate the inflammatory damage effect of IL-18 on SCZ,thereby reducing the positive symptoms.

Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.

Objective:To investigate the effect of inspiratory muscle training on diaphragm morphology and function in ventilator induced diaphragmatic dysfunction(VIDD)rats,and to explore the mechanism of it.Method:Twenty-four adult female SD rats were randomly divided into 4 groups:①Control group(n=6);②Me-chanical ventilation group(n=6):mechanical ventilation for 24 hours;③Sham training group(n=6):spontane-ous breathing for 1 hour after mechanical ventilation for 24 hours;④Training group(n=6):intermittent inspi-ratory muscle training for 1 hour after mechanical ventilation for 24 hours.Multi-channel physiology signal col-lection and processing system were used to detect the peak twitch tension and peak tetanic force of dia-phragm,as well as the frequency-force effect curve.The cross-sectional area(CSA)of diaphragm was ob-served by hematoxylin and eosin staining method.Western-blot was used to detect the level of microtubule-as-sociated protein 1 light chain 3(LC3)and muscle atrophy F-box(MAFbx).The levels of αII-spectrin break-down products(SBDPs)SBDP145 and SBDP120 in the diaphragm were detected by ELISA.The level of malondialdehyde(MDA)in the diaphragm was detected by thiobarbituric acid(TBA)method.Result:Compared with control group and training group,the peak twitch tension,peak tetanic force and fre-quency-force effect curve of diaphragm in ventilation group and sham training group were decreased significant-ly(P<0.05),but there was no difference between the ventilation group and the sham training group or be-tween the control group and the training group.Compared with the control group,the diaphragm fiber cross-sectional area of ventilation group,sham training group or training group was significantly decreased(P<0.05),and there was no significant difference between the ventilation group and the sham training group.Compared with the ventilation group and the sham training group,the diaphragm fiber cross-sectional area of training group was increased(P<0.05).Compared with the control group,the level of MDA,SBDP120 and LC3II/I ratio in the diaphragm of ventilation group,sham training group and training group were significantly in-creased(P<0.05),and there was no difference between the ventilation group,the sham training group and the training group.Compared with the control group,the expression of MAFbx in ventilation group was signif-icantly increased(P<0.05),and there was no difference between the ventilation group,the sham training group and the training group.Compared with the control group and the training group,SBDP145 level in the diaphragm of ventilation group or sham training group was significantly increased(P<0.05),but there was no difference between the ventilation group and the sham training group.There was no difference in SBDP145 lev-el of diaphragm between the control group and the training group.Conclusion:Inspiratory muscle training can improve the morphology and function of VIDD diaphragm,and the mechanism may be related to the decrease of calpain activity.

Objective To explore the preventive effect of auricular point bean embedding on sufentanil-induced cough reflex during induction of general anesthesia undergoing breast mass resection.Methods Clinical data of patients undergoing elective mammary mass resection with general anesthesia from June 2021 to May 2023 were retrospectively collected.The patients who received auricular point bean embedding therapy before surgery were included in the observation group,and patients who did not receive auricular point bean embedding therapy before surgery were included in the control group.The propensity score matching(PSM)method was used to perform 1∶1 matching based on basic data.The time effect,intergroup effect and interaction effect of vital signs parameters were analyzed by repeated measures analysis of variance.The GEE was used to analyze visual analogue scale(VAS)at different time points after operation.The Log-binomial regression model was used to analyze the incidence of postoperative adverse reactions and the association between subtypes.Results After PSM,50 patients were included in the observation and control groups.The time effect,intergroup effect and interaction effect of systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SpO2)in 2 groups were statistically significant(P＜0.05).Within the same group,SBP,DBP,MAP,HR and SpO2 were statistically significant at immediately after intravenous sufentanil injection(T1),2 min after injection(T2),1 min before intubation(T3)and 1 min after intubation(T4)(P＜0.05).At T2,SBP,DBP,MAP and HR in the observation group were significantly lower than those in the control group,and SpO2 was significantly higher than that in the control group(P＜0.05).The cough control,VAS score and total incidence of postoperative adverse reactions in the observation group were significantly better than those in the control group(P＜0.05).The result of GEE model analysis showed that the improvement of postoperative VAS scores of patients in the observation group was better than that in the control group(P＜0.05).Conclusion Preoperative auricular point bean embedding has a specific preventive effect on sufentanil induced cough reaction in patients with breast mass resection under general anesthesia.