ObjectiveThis paper aims to study the potential active compound components and action mechanism of Shenqi Dihuangtang in the treatment of diabetic kidney disease （DKD） through network pharmacology and in vivo experimental verification. MethodsUltra-high-performance liquid chromatography-Q-exactive orbitrap mass spectrometry （UPLC-Q-Exactive Orbitrap MS） technology was used to clarify the main active chemical components of Shenqi Dihuangtang， and it was combined with network pharmacology methods such as gene ontology （GO） functional annotations and Kyoto encyclopedia of genes and genome （KEGG） to predict the potential action mechanism of Shenqi Dihuangtang in treating DKD. Subsequently， the DKD model of db/db male mice was established， and the mice were randomly divided into model group， low-dose Shenqi Dihuangtang group （6.10 g·kg^-1）， medium-dose Shenqi Dihuangtang group （12.19 g·kg^-1）， high-dose Shenqi Dihuangtang group （24.38 g·kg^-1）， and daplizin group （1.25 mg·kg^-1）. During the same period， C57BL/6J male mice were selected into normal group and received drug intervention for 8 weeks， respectively. During this period， the body weight and fasting blood glucose （FBG） of the mice were dynamically monitored， and oral glucose tolerance test （OGTT） and insulin tolerance test （ITT） were performed at the end of dosing. The levels of serum creatinine （SCr）， blood urea nitrogen （BUN）， uric acid （UA）， albumin （ALB）， and total protein （TP） were measured by an automatic biochemical analyzer， and 24-hour urine protein was measured by a urine protein quantitative kit. Hematoxylin-eosin （HE）， periodic-acid Schiff （PAS）， and Masson staining were employed to observe the renal histopathology. The expression of nephrotic protein Nephrin was observed by immunohistochemistry. Western blot was used to detect the expression of epithelial-mesenchymal transition （EMT）-related proteins such as TGF-β₁， Smad2/3， α-smooth muscle actin （α-SMA）， neural-cadherin （N-Cadherin）， and snail protein. ResultsUPLC-Q-Exactive Orbitrap MS identified 384 active compounds in the aqueous extract of Shenqi Dihuangtang. According to oral bioavailability≥30% and the five drug-like principles， 44 key active ingredients were screened out， and 169 intersection targets highly correlated with DKD were matched. Among them， there was a significant interaction relationship between tumor necrosis factor（TNF）， interleukin（IL）-6， protein kinase B（Akt）1， Caspase-3， Jun proto-oncogene （JUN）， hypoxia inducible factor-1α（HIF-1α）， B cell lymphoma-2（Bcl-2）， matrix metallopeptidase-9（MMP-9）， IL-1β， and TGF-β₁. GO functional annotations were significantly enriched in cellular components such as membrane rafts， membrane microdomains， and collagen-containing extracellular matrix， molecular functions such as DNA-binding transcription factor binding， R-Smad binding， and Smad protein binding， as well as biological processes such as reactions to lipopolysaccharides（LPS）， reactions to bacteria-derived molecules， and wound healing. The KEGG pathway was significantly enriched in lipids and atherosclerosis， TGF-β signaling pathway， phosphatidylinositol 3 kinase （PI3K）/Akt signaling pathway， etc. In vivo experimental results showed that the high-dose Shenqi Dihuangtang group could significantly reduce FBG levels in db/db mice （P<0.01）， improve OGTT （P<0.01） and ITT （P<0.01） levels， reduce SCr （P<0.01）， BUN （P<0.01）， UA （P<0.01） and 24-hour BUN （P<0.01）， and increase ALB （P<0.01） and TP （P<0.01） levels. Pathological staining confirmed that the high-dose Shenqi Dihuangtang group could significantly reduce the glomerular mesangial matrix area and collagen deposition （P<0.01） and upregulate the positive expression rate of Nephrin （P<0.01）. Western blot results showed that the high-dose Shenqi Dihuangtang group significantly downregulated the expression of TGF-β₁ （P<0.01） and Smad2/3 （P<0.01） signal molecules and inhibited the protein levels of α-SMA （P<0.01）， N-Cadherin （P<0.01）， and Snail （P<0.01）. ConclusionShenqi Dihuangtang can inhibit the TGF-β₁/Smad signaling axis and block the renal EMT process， thereby improving DKD renal fibrosis damage. Further analysis of its key active components and clinical transformation pathways is needed in the future.

Objective: To explore the correlation between small intestinal bacterial overgrowth(SIBO) and cognitive impairment in patients undergoing peritoneal dialysis(PD). Methods: 60 PD patients and 46 non-dialysis patients with end-stage renal disease(ESRD) were included in this study. SIBO was detected by lactulose hydrogen methane breath test(LHMBT). The cognitive function levels of the subjects were evaluated using the Montreal cognitive assessment(MoCA) and mini-mental state examination(MMSE). The emotional states of the patients were assessed by self-rating anxiety scale(SAS) and self-rating depression scale(SDS). The gastrointestinal symptoms were evaluated using gastrointestinal symptom rating scale(GSRS). According to the results of LHMBT, the PD patients were further divided into two subgroups: SIBO-positive and SIBO-negative. The general conditions, laboratory data, and scores of each scale were compared between the two groups. Furthermore, according to the MoCA scores, the PD patients were divided into two groups: those with normal cognitive function and those with cognitive dysfunction. The positive rates of SIBO between the two groups were compared. Binary Logistic stepwise regression was used to explore whether SIBO was an independent risk factor for cognitive impairment in PD patients. At the same time, other independent influencing factors for cognitive impairment in PD patients were analyzed. Results: The positive rate of SIBO in PD patients was 40.00%. Among them, the positive rate of SIBO in the group with normal cognitive function during peritoneal dialysis was 27.27%, and the positive rate of SIBO in the group with cognitive dysfunction during peritoneal dialysis was 55.56%. There was a statistically significant difference in the positive rate of SIBO between the two groups(P=0.026). Further analysis by multivariate Logistic stepwise regression showed that in addition to age(OR=1.118, 95%CI 1.007-1.242, P=0.037), educational attainment(OR=0.655,95%CI 0.442-0.972,P=0.036), and hemoglobin(OR=0.946,95% CI 0.895-0.998,P=0.044), SIBO(OR=7.613,95% CI 1.160-49.979,P=0.034)was also an independent risk factor for cognitive impairment in PD patients. Conclusion The incidence of SIBO in PD patients is relatively high and is associated with multiple factors, among which SIBO may be closely related to cognitive dysfunction in PD patients.

Objective:To establish a reference interval for serum iodine of pregnant women with normal thyroid function and to analyze the relationship between serum iodine and thyroid disease risk.Methods:From July 2022 to October 2023, using cross-sectional survey method, pregnant women aged 18 to 48 years old who had lived in iodine-deficient areas in the six provinces of China (Shanxi Province, Fujian Province, Yunnan Province, Xinjiang Uygur Autonomous Region, Zhejiang Province, and Anhui Province) for more than six months were selected as the survey subjects. Blood samples were collected, serum iodine was tested, and the percentile method was used to establish a reference interval for serum iodine of pregnant women with normal thyroid function. Meanwhile, serum levels of free thyroxine, thyroid stimulating hormone, thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were tested, and logistic regression was used to analyze the relationship between serum iodine and thyroid disease risk.Results:A total of 1 409 pregnant women from 6 provinces were investigated, including 1 087 with normal thyroid function and 322 with abnormal thyroid function. The median serum iodine level of pregnant women with normal thyroid function was 79.74 μg/L, and the preliminary reference interval for serum iodine was 47.57 - 128.96 μg/L. When serum iodine levels were lower (< 47.57 μg/L), pregnant women had a significantly increased risk of developing TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis ( OR = 4.44, 2.91, 3.41, 41.67, 23.43, P < 0.05). When serum iodine levels were high (> 128.96 μg/L), pregnant women had a significantly increased risk of developing hyperthyroidism ( OR = 9.91, P = 0.001). Conclusions:The reference interval for serum iodine of pregnant women with normal thyroid function is successfully established. Low serum iodine levels are associated with an increased risk of TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis, while high serum iodine levels are associated with an increased risk of hyperthyroidism.

Objective:To establish a reference interval for serum iodine of pregnant women with normal thyroid function and to analyze the relationship between serum iodine and thyroid disease risk.Methods:From July 2022 to October 2023, using cross-sectional survey method, pregnant women aged 18 to 48 years old who had lived in iodine-deficient areas in the six provinces of China (Shanxi Province, Fujian Province, Yunnan Province, Xinjiang Uygur Autonomous Region, Zhejiang Province, and Anhui Province) for more than six months were selected as the survey subjects. Blood samples were collected, serum iodine was tested, and the percentile method was used to establish a reference interval for serum iodine of pregnant women with normal thyroid function. Meanwhile, serum levels of free thyroxine, thyroid stimulating hormone, thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were tested, and logistic regression was used to analyze the relationship between serum iodine and thyroid disease risk.Results:A total of 1 409 pregnant women from 6 provinces were investigated, including 1 087 with normal thyroid function and 322 with abnormal thyroid function. The median serum iodine level of pregnant women with normal thyroid function was 79.74 μg/L, and the preliminary reference interval for serum iodine was 47.57 - 128.96 μg/L. When serum iodine levels were lower (< 47.57 μg/L), pregnant women had a significantly increased risk of developing TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis ( OR = 4.44, 2.91, 3.41, 41.67, 23.43, P < 0.05). When serum iodine levels were high (> 128.96 μg/L), pregnant women had a significantly increased risk of developing hyperthyroidism ( OR = 9.91, P = 0.001). Conclusions:The reference interval for serum iodine of pregnant women with normal thyroid function is successfully established. Low serum iodine levels are associated with an increased risk of TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis, while high serum iodine levels are associated with an increased risk of hyperthyroidism.

Objective:To analyze the influencing factors of thyroid volume in children aged 8 - 10 in Yunnan Province, and provide scientific basis for improving iodine deficiency disorders monitoring.Methods:From March to July 2020, in 129 counties (cities, districts) under the jurisdiction of Yunnan Province, each county (city, district) was divided into 5 sampling areas based on east, west, south, north, and middle. One township was selected from each area, and 40 non-boarding children aged 8 - 10 from one primary school were selected from each township (age balanced, half male and half female) as survey subjects. One random urine sample and household edible salt samples were collected for urine iodine and salt iodine testing, and physical examination and thyroid volume measurement were conducted for children. The influencing factors of thyroid volume were analyzed using Pearson correlation.Results:A total of 24 934 urine samples were collected from children, with a median urine iodine of 233.2 μg/L. A total of 24 933 household edible salt samples were collected from children, the median salt iodine was 24.17 mg/kg, and the qualified rate of iodized salt was 96.63% (24 003/24 839); A total of 24 937 children were examined of their thyroid gland, with a median thyroid volume of 2.62 ml and a goiter rate of 1.12% (280/24 937). Among them, there were 12 410 boys and 12 527 girls, with thyroid volumes of 2.61 and 2.64 ml, respectively. The thyroid volume of boys was positively correlated with age, height, weight, body mass index, body surface area, and salt iodine ( r = 0.15, 0.21, 0.26, 0.18, 0.25, 0.03, P < 0.001). The thyroid volume of girls was positively correlated with age, height, weight, body mass index, and body surface area ( r = 0.17, 0.26, 0.28, 0.17, 0.27, P < 0.001). Conclusion:Children aged 8 - 10 in Yunnan Province are at an iodine excess level; the age, weight, height, body mass index, and body surface area are influencing factors of thyroid volume.

Objective:To evaluate the role of hippocampal β4-Subunit-Containing Nicotinic Acetylcholine Receptors (Chrnb4) in postoperative delirium in aged mice.Methods:Forty-eight SPF male C57BL/6J mice, aged 18 months, weighing 29-35 g, were assigned into 6 groups using a random number table method: tibial fracture group (TF group, n=6), sham operation group (Sham group, n=6), tibial fracture + adipenine group (TA group, n=9), tibial fracture + control vehicle group (TV group, n=9), sham operation + adipenine group (SA group, n=9), and sham operation + control vehicle group (SV group, n=9). The postoperative delirium model was prepared by tibial fracture under sevoflurane anesthesia. Tibial fracture was simulated by implanting a steel pin into the tibia and then clamping it, while sham group only received a longitudinal incision and suture after anesthesia. A microinjection cannula was implanted into the mouse skull at 5 days before developing the model in TA group, TV group, SA group and SV group. Three mice from each group were randomly selected for microelectrode implantation in the hippocampal CA1 area. Starting from 30 min after surgery, adipenine (62.5 nmol/μl) 2 μl was infused into the cerebral ventricle for 7 consecutive days in TA and SA groups, and vehicle (2 μl) was administered instead at a 24-h interval for 7 consecutive days in TV and SV groups. The expression of Chrnb4 mRNA in the hippocampal tissues was detected by real-time quantitative polymerase chain reaction at 24 h after surgery. On the 7th and 8th days after surgery, the open-field test and O-maze experiment were conducted to assess the impulsive-like behavior in TA, TV, SA and SV groups. After the behavioral test, the expression of glial fibrillary acidic protein (GFAP) and vesicular glutamate transporter 1 (Vglut1) in the hippocampal CA1 region was detected by immunofluorescence staining. The local field potentials in the hippocampal CA1 region were recorded during the open field test. Results:The expression of Chrnb4 mRNA in the hippocampal tissues was significantly up-regulated in TF group compared to Sham group ( P<0.05). Compared with TV group, the percentage of central path distance in the open field test and percentage of time spent in the open arms of the O-maze were significantly decreased, the power of β-waves in the CA1 field potentials was decreased, the expression of GFAP and Vglut1 in the hippocampal CA1 region was down-regulated, and the co-staining area of GFAP + and Vglut1 + was decreased in TA group and SV group ( P<0.05). There was no significant difference in each parameter between SA group and SV group ( P>0.05). Conclusions:Hippocampal Chrnb4 may be involved in the mechanism of postoperative delirium in aged mice, and this process may be related to inhibition of neuron excitotoxicity.

Objective This study aims to assess the effect of Problem-Based Learning(PBL)and Case-Based Learning(CBL)based on the Plan-Do-Check-Act(PDCA)cycle on the quality control training for clinical residents in medical record writing on the first page.Methods A total of 293 clinical residents who participated in first page of medical record writing train-ing in 2021 in a hospital were selected as control group,and 243 clinical residents who participated in first page of medical record writing training in 2022 were selected as observation group.The control group were trained only with the PBL+CBL teaching method,while the observation group with the PDCA cycle in combination with PBL+CBL teaching methods.Upon completion of the training,the two groups were compared in terms of scores on basic theoretical examinations.Results The observation group showed a significantly higher average theoretical score compared to the control group(84.41±12.27 vs.74.32±14.39,P＜0.05).Conclusion PBL and CBL teaching methods based on PDCA cycle can enhance the effect of quality control training for clinical residents in medical record writing on the first page,ultimately improving the quality of medical record writing on the first page and ensuring that objectivity,accuracy,and authenticity of information on the first page.

Objective:To investigate the iodine nutritional status of adults and pregnant women in Jianshui County and Zhenxiong County, Yunnan Province.Methods:From May to August 2021, one urban area and one rural area in Jianshui County and Zhenxiong County, Yunnan Province were selected as investigation sites. At least 100 adults (half male and half female) and 100 pregnant women were selected as survey subjects in each investigation site. Random urine samples were collected from all survey subjects once to detect urine iodine, creatinine and sodium contents. Venous blood samples of all pregnant women were collected to detect the serum iodine content, and the 95% medical reference range of serum iodine was established using the percentile method.Results:The medians urinary iodine, creatinine and sodium of adults in Jianshui County and Zhenxiong County were 184.7 μg/L ( n = 432), 12 355.0 μmol/L ( n = 431) and 156.5 mmol/L ( n = 420), respectively. The median urinary iodine of adults in Jianshui County was higher than that in Zhenxiong County (197.3 vs 170.2 μg/L), the difference was statistically significant ( Z = - 2.90, P = 0.003). The median serum iodine of pregnant women in Jianshui County and Zhenxiong County was 92.1 μg/L ( n = 412), with a 95% medical reference value ranged from 45.3 to 183.5 μg/L; the medians urinary iodine, creatinine and sodium of pregnant women were 138.6 μg/L ( n = 413), 12 173.0 μmol/L ( n = 408) and 152.2 mmol/L ( n = 409), respectively. The urinary iodine (154.1 vs 115.8 μg/L), urinary creatinine (13 216.0 vs 11 376.0 μmol/L) and urinary sodium (161.8 vs 141.8 mmol/L) of pregnant women in Jianshui County were higher than those in Zhenxiong County, with statistical differences ( Z = - 5.12, - 2.29, - 4.30, P < 0.05). Conclusion:Adults in Jianshui County and Zhenxiong County are at an appropriate level of iodine, but pregnant women in Zhenxiong County are at an iodine deficiency level.

Objective Based on the problems existing in the DRG grouping of non-enrolled medical records in a tertiary hospital,analyze the impact of disease nature on surgical coding,propose solutions,and continuously improve the quality of med-ical record data.Methods From January to June 2022,the medical records reported to the DRG group in the medical records room were found by the data center platform of the DRG inpatient medical service detection and analysis system,and the number of cases in which the medical records were not included in the DRG group due to the disease nature of the surgical operation name was found,and the defects were cited,classified,counted and analyzed.And the statistical analysis of the cost before and after the revision of the surgical code,and discuss the solution.Results After statistical analysis,it was found that the causes of 377 non enrolled medical records were related to the main diagnosis and surgical procedures,accounting for 85.46%.The main diag-nosis and surgical procedures were 55 cases of mismatched surgical procedure codes due to the nature of the disease.Conclusion The issue of not being included in the medical record is essentially a matter of the nature of the disease and surgical procedures in the main diagnosis.Medical record information managers should strengthen the management and training methods of medical record writing,improve their ability to diagnose and write medical records,ensure the accuracy of medical record homepage data and DRG grouping data,and improve enrollment rates.

Objective:To evaluate the efficacy of certolizumab pegol (CZP) in the treatment of Chinese women of childbearing age with inflammatory joint diseases and the effect of intrauterine exposure on infant vaccination and risk of infection.Methods:This study is a retrospective observation study, including female patients of childbearing age who were treated with CZP in the outpatient clinic from November 2019 to October 2020. The patients were followed up for 24 weeks, and the related data was collected. We adopted disease activity score-28 for rheumatoid arthritis with CRP (DAS28-CRP), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) to evaluate disease activity. Bath ankylosing spon-dylitis disease activity index (BASDAI) and ankylosing spondylitis disease activity score (ASDAS-ESR) were used to assess the disease activity of patients with ankylosing spondylitis or spondyloarthritis (AS/SpA). Low disease activity (LDA), the dosage of glucocorticoid (GC) and the qualified rates of ACR20 and ASAS20 were calculated to validate the efficacy of CZP. The data of infants vaccination and infection was recorded to estimate the effect of intrauterine exposure on infants. Correlation analysis were performed using paired t test or Mann Whitney test. All statistical tests were bilateral, with a significance of P<0.05. Results:Twenty women entered the study and fifteen completed, including eight patients with RA, six patients with AS and 1 patient with SpA. The average age was (30±5) years and the median symptom duration was 5.0 (3.0, 6.5) years. When these RA patients were enrolled into the study, DAS28-CRP, CDAI and SDAI were (3.4±1.2), 15.5(9.5, 21.0) and (18±12) respectively; and after the use of CZP, the DAS28-CRP, CDAI and SDAI changed to (2.5±0.9)( t=2.48, P=0.042), 4.5(3.5, 10.8) ( U=12.50, P=0.040) and (9±6) (t=2.76, P=0.028). At the first follow-up, the ACR20 rate was 50%. and at the end of the study, the LDA rate was 75%(6/8), three(37.5%) women reduced the dosage of GC. Among the AS/SpA patients, BASDAI was 19.0(14.5, 26.0) and ASDAS-ESR was (2.4±1.0) at first, while after treatment, BASDAI turned into 9.0(1.0, 10.5) ( U=11.50, P=0.100) and ASDAS-ESR turned into (1.4±0.5) ( t=3.44, P=0.014). The ASAS20 rate at the first follow-up was 71.4%(5/7), and 85.7%(6/7) at the end of the study. Four patients experienced adverse events, resulting in drug withdrawal. Three women were pregnant when they were enrolled into the study, and three others became pregnant during the research. Six infants were vaccinated with live attenuated vaccines and inactivated vaccines according to the plan. No adverse event related to vaccination was reported, but one of the babies had perianal abscess and the other one had cold symptoms, while both improved after treatment. Conclusion:CZP can effectively control disease activity of women with inflammatory joint diseases during pregnancy, and intrauterine exposure is safe to infants during the study period.