Objective:To investigate the effectiveness and safety of low-dose oral misoprostol solution for cervical ripening in late gestation.Methods:This was a prospective cohort study including 396 primiparas with singleton pregnancy who received low-dose oral misoprostol solution for cervical ripening (oral group) in Peking University Third Hospital from March to October 2022. They were further allocated to receive oral misoprostol alone (OA group, n=167) or oral misoprostol in combination with oxytocin/amniotomy (OC group, n=229). Moreover, 218 cases who received vaginal misoprostol for cervical ripening (vaginal group) during the same period in 2021 were reviewed (a retrospective cohort). Among them, 77 were given vaginal misoprostol alone (VA group) and 141 received vaginal misoprostol in combination with oxytocin/amniotomy (VC group). The OA group and VA group (72 and 73 cases) as well as the OC group and VC group (108 and 103 cases) were matched using propensity scores. Basic clinical information, hospital stay, duration of labor induction, uterine hyperstimulation, rate of labor initiation, vaginal delivery rate, rate of delivery within 24 h, duration of labor, neonatal condition, adverse pregnancy outcomes, and other information were compared between different groups. All data were statistically analyzed using independent sample t test, analysis of variance, nonparametric test, Chi-square test, or Fisher's exact probability test. Logistic regression model was used to analyze the factors affecting the labor initiation and the failure of labor induction. Results:The average hospital stay, the duration from medication to labor initiation and the duration from medication to vaginal delivery were significantly shorter in the oral group than those in the vaginal group [(5.4±2.4) vs. (6.5±2.6) d, (34.2±24.1) vs. (38.9±25.7) h, (45.8±25.8) vs. (53.4±27.8) h; t=5.24, 2.10 and 3.39; all P<0.05]. The total labor initiation rate and vaginal delivery rate in the oral group were significantly higher than those in the vaginal group [92.9% (368/396) vs. 83.5% (182/218), 72.2% (286/396) vs. 60.1% (131/218); χ 2=13.43 and 9.50; both P<0.05]. The incidence of failed induction of labor, uterine hyperstimulation, fetal distress, and intrauterine infection in the oral group were lower than those in the vaginal group [2.0% (8/396) vs. 6.9% (15/218), 4.3% (17/396) vs. 17.9% (39/218), 8.8% (35/396) vs. 14.7% (32/218), 1.3% (5/396) vs. 3.7% (8/218); χ 2=9.21, 31.36, 4.93 and 3.93; all P<0.05]. The duration from medication to labor initiation and to vaginal delivery in the OA group were higher than those in the VA group [(25.8±17.0) vs. (17.4±10.8) h, (37.2±18.8) vs. (29.7±13.5) h; t=3.49 and 2.74; both P<0.05]. There were no significant differences in the labor initiation rate, vaginal delivery rate, rate of delivery within 24 h or the incidence of failed induction of labor between the OA and VA groups (all P>0.05). Women in the VA group were more likely to develop uterine hyperstimulation than those in the OA group [19.2% (14/73) vs. 4.2% (3/72), χ2=7.89, P=0.005]. There were no significant differences in the duration from medication to labor initiation or to vaginal delivery between the VC and OC groups (both P>0.05), but the duration were significantly longer than those in the corresponding medication alone group (VC vs. VA groups: (49.7±24.6) vs. (17.4±10.8) h and (61.6±25.7) vs. (29.7±13.5) h, t=5.31 and 5.13, both P<0.05; OC vs. OA groups: (45.3±26.6) vs. (25.8±17.0) h and (56.1±27.2) vs. (37.2±18.8) h, t=10.35 and 9.78, both P<0.05]. The labor initiation rate, vaginal delivery rate and rate of delivery within 24 h in the OC group were higher than those in the VC group [88.9% (96/108) vs. 77% (87/113), 63.0% (68/108) vs. 47.8% (54/113), 10.3% (7/108) vs. 0.0% (0/113); χ 2=5.49, 5.14 and 7.56; all P<0.05]. The incidence of uterine hyperstimulation in the OC group was 4.6% (5/108), which was lower than that in the VC group [18.6% (21/113), χ 2=10.37, P=0.001]. Logistic regression analysis showed that oral misoprostol and gestational age were positively correlated with labor initiation [ OR (95% CI): 2.18 (1.24-3.90) and 1.43 (1.14-1.79)], while maternal age was negatively correlated with labor initiation [ OR (95% CI): 0.90 (0.82-0.98)]. Moreover, failed induction of labor was negatively correlated with oral misoprostol [ OR (95% CI): 0.37 (0.14-0.91)], but positively correlated with maternal age [ OR (95% CI): 1.21 (1.05-1.40)]. Conclusions:Oral administration of low-dose misoprostol solution is as effective as vaginal misoprostol in promoting cervical ripening. Besides, it can shorten the average hospital stay and reduce the incidence of uterine hyperstimulation, suggesting that low-dose oral misoprostol solution is relatively safer and can be used to promote cervical ripening in late gestation.

ObjectiveTo observe the effects of Danggui Buxuetang on the mitochondrial fission and apoptosis of podocytes in the rat model of diabetic kidney disease （DKD） and to explore the protective effect and mechanism of Danggui Buxuetang on DKD rats. MethodSD rats were randomized into a modeling group （n=65， fed with a high-sugar and high-fat diet） and a normal group （n=10， fed with a normal diet）. After 6 weeks， the modeled rats were injected intraperitoneally with streptozotocin （STZ） for the modeling of type 2 diabetes mellitus （T2DM）. Sixty T2DM rats were randomized into model， irbesartan （0.014 g·kg^-1）， and low-， medium-， and high-dose （0.36， 0.72， 1.44 g·kg^-1， respectively） Danggui Buxuetang groups and administrated with corresponding drugs by gavage for 16 weeks. The levels of fasting blood glucose （FBG） and 24 h urinary protein （24 h UTP） were determined at the end of the 16th week. The pathological changes of the renal tissue were observed by hematoxylin-eosin and Masson staining. The mitochondrial ultrastructure of rat podocytes was observed by transmission electron microscopy. The level of reactive oxygen species （ROS） in the renal tissue of rats was measured by the fluorescent probe labeling of dihydroethidium （DHE）. The apoptosis of renal cells was detected by terminal-deoxynucleotidyl transferase-mediated dUTP nick end labeling （TUNEL）. The expression levels of Synaptopodin， Podocin， and cleaved caspase-3 in renal podocytes were detected by the immunohistochemical method （IHC）. Western blot was employed to determine the protein levels of A-kinase anchoring protein 1 （AKAP1）， phosphorylated dynamin-related protein 1 （p-Drp1）， mitofusin-2 （Mfn2）， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein （Bax）. ResultCompared with the control group， the model group showed elevated levels of FBG and 24 h UTP， mesangial hyperplasia， basement membrane thickening， mitochondrial swelling， mitochondrial crista breakage and disorder， and increased ROS and TUNEL-positive cells. In addition， the model group showcased down-regulated expression of Synaptopodin and Podocin， increased expression of cleaved Caspase-3， up-regulated protein levels of AKAP1 and p-Drp1 ， and down-regulated protein levels of Mfn2 and Bcl-2/Bax （P<0.01）. Compared with the model group， high-dose Danggui Buxuetang lowered the levels of FBG and 24 h UTP， alleviated the pathological injuries of the renal tissue and the mitochondrial injury of podocytes， decreased ROS and TUNEL-positive cells， promoted the expression of Synaptopodin and Podocin， inhibited the expression of cleaved Caspase-3， down-regulated the protein levels of AKAP1 and p-Drp1， and up-regulated the protein levels of Mfn2 and Bcl-2/Bax （P<0.05， P<0.01）. ConclusionDanggui Buxuetang may inhibit mitochondrial fission and apoptosis of podocytes and reduce urine protein by regulating the AKAP1/Drp1 pathway， thereby delaying the progression of DKD.

Depression is a common cause of human disability and death.Some patients are not sensitive to antidepressants,and also the recurrence rate is very high.Unfortunately,there are many problems with existing antidepressants.So,it is urgent to find a new antidepressant aiming at multiple targets.Recently,researchers have found that soluble N-ethylmaleimide-sensitive factor attachment protein receptor(SNARE)complex is closely related to the progression of depression.This review discusses the potential mechanisms of the SNARE complex in glial cells,and hopes to contribute to the understanding of depression and provide new ideas for clinical development of novel antidepressant drugs.

Objective:To explore the risk factors of septic acute kidney injury (sAKI) in patients with sepsis, construct a predictive model for sAKI, verify the predictive value of the model, and develop a dynamic nomogram to help clinical doctors identify patients with high-risk sAKI earlier and more easily.Methods:A cross-sectional study was conducted. A total of 245 patients with sepsis admitted to intensive care unit (ICU) of the Affiliated Hospital of Jining Medical University from May 2013 to November 2023 were enrolled as the research subjects. The patients were divided into sAKI group and non-sAKI group based on whether they suffered from sAKI during ICU hospitalization. The differences of the demographic, clinical and laboratory indicators of patients between the two groups were compared. Logistic ordinal regression analysis was performed to analyze the imbalanced variables between the two groups, and to construct a sAKI predictive model. The predictive value of the sAKI predictive model was evaluated through 5-fold cross validation, calibration curve, and decision curve analysis (DCA), and to develop an online dynamic nomogram for the predictive model.Results:A total of 245 patients were enrolled in the final analysis. 110 (44.9%) patients developed sAKI during ICU hospitalization and 135 (55.1%) patients did not develop sAKI. Compared with the non-sAKI group, the patients in the sAKI group had higher ratios of female, hypertension, invasive mechanical ventilation (IMV), renal replacement therapy (RRT), vasopressin usage, and neutrophil count (NEU), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (SCr), uric acid (UA), Na +, K +, procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, and sequential organ failure assessment (SOFA) score. Multivariate Logistic ordinal regression analysis showed that female [odd ratio ( OR) = 2.208, 95% confidence interval (95% CI) was 1.073-4.323, P = 0.020], hypertension ( OR = 2.422, 95% CI was 1.255-5.073, P = 0.012), vasopressin usage ( OR = 2.888, 95% CI was 1.380-6.679, P = 0.002), and SCr ( OR = 1.015, 95% CI was 1.009-1.024, P < 0.001) were independent risk factors for sAKI in septic patients, and a sAKI predictive model was constructed: ln[ P/(1+ P)] = -4.665+0.792×female+0.885×hypertension+1.060×vasopressin usage+0.015×SCr. The 5-fold cross validation showed that the average area under the receiver operator characteristic curve (AUC) was 0.860, indicating the sAKI predictive model had a good performance. The calibration curve analysis showed that the calibration degree of the sAKI predictive model was good. DCA showed that the net profit of the sAKI predictive model was relatively high. A static nomogram and an online dynamic nomogram were constructed for the sAKI predictive model. Compared with the static nomogram, the dynamic nomogram allowed for manual selection of corresponding patient characteristics and viewing the corresponding sAKI risk directly. Conclusions:Female, hypertension, vasopressin usage, and SCr are the main risk factors for sAKI in patients with sepsis. The sAKI predictive model constructed based on these factors can help clinical doctors identifying high-risk patients as early as possible, and intervene in a timely manner to provide preventive effects. Compared with the common static nomogram, online dynamic nomogram can make predictive models clearer, more intuitive, and easier.

Objective:To observe the effects of point application,ear point pressing therapy,plus mometasone furoate nasal spray on inflammatory cells and immune function in patients with allergic rhinitis(AR). Methods:Fifty AR patients who received point application,ear point pressing therapy,and mometasone furoate nasal spray for treatment were recruited as an observation group.Simultaneously,another 50 AR patients who only used the same nasal spray were enrolled as a control group.The clinical efficacy was compared between the two groups,and the inflammatory cell count and immune function changes were observed after treatment. Results:The observation group had a higher total effective rate than the control group(P<0.05).After treatment,significant decreases were noticed in the total nasal symptom score,eosinophils count in nasal secretions,and serum immunoglobulin E(IgE)level in both groups(P<0.05),and the observation group was significantly lower than the control group(P<0.05). Conclusion:Combining point application,ear point pressing therapy,and mometasone furoate nasal spray can produce satisfactory treatment results for AR.This method is safe and can reduce inflammatory responses and improve immune function.

ObjectiveTo observe the clinical effect of modified Yinqiaosan combined with antibiotics in the treatment of acute tonsillitis in children with wind-heat invading lung syndrome. MethodA total of 96 children with acute tonsillitis of wind-heat invading the lung syndrome were randomized into control group and observation group. The control group was treated with routine antibiotics， and the observation group was treated with modified Yinqiaosan and antibiotics for 7 days. The scores of major symptoms （sore throat， erythmatous throat， dysphagia， erythmatous tonsils and suppuration） and minor symptoms （fever， cough， stool， and tongue） and the levels of inflammation- and immune-related indexes ［white blood cell （WBC）， C-reactive protein （CRP）， serum amyloid A （SAA）， interleukin-6 （IL-6）， and interferon-γ （IFN-γ）］ were compared between two groups. ResultThe data of 92 children were statistically analyzed： 45 in the observation group and 47 cases in the control group. The total clinical effective rate of the observation group was 95.56%， as compared with the 93.62% of the control group. After treatment， the scores of major symptoms in the observation group were lower than those in the control group （P<0.05）， and the scores of cough， defecation， and tongue in the observation group were lower than those in the control group （P<0.05）. The levels of inflammation- and immune-related indexes after treatment in the observation group were lower than those before treatment （P<0.05）. Except IFN-γ， the levels of the inflammation- and immune-related indexes in the control group were lower than those before treatment （P<0.05）. After treatment， the levels of SAA and IL-6 in the observation group were lower than those in the control group （P<0.05）. ConclusionModified Yinqiaosan combined with antibiotics can significantly reduce the expression of SAA and IL-6 in the treatment of children with acute tonsillitis， thereby alleviating inflammation and clinical symptoms and improving prognosis.

Objective:To investigate the value of multi-slice spiral CT (MSCT) combined with three myocardial markers in the diagnosis of acute chest pain etiology.Methods:A retrospective study was conducted on 120 patients with acute chest pain admitted to the Affiliated Hospital of Jining Medical University from January 2020 to December 2020. All patients underwent MSCT imaging examination upon admission, and serum creatine kinase isoenzyme MB (CK-MB), troponin I (cTnI), and myoglobin (MYO) levels were also tested. The final clinical diagnosis was used as the judgment standard to draw a 2×2 four-square table, and calculate the value of MSCT, CK-MB, cTnI, and MYO in the diagnosis of acute chest pain etiology.Resultsl:Among the 120 acute chest pain patients included, 75 were diagnosed with acute coronary syndrome (62.50%), 16 with aortic dissection (13.33%), and 29 with pulmonary embolism (24.17%). The coincidence rate of MSCT diagnosis of coronary heart disease was 86.67%(65/75), the diagnosis of aortic dissection coincidence rate was 12/16, and the diagnosis of pulmonary embolism coincidence rate was 75.86%(22/29). The serum CK-MB, cTnI, and MYO levels in the coronary heart disease group were significantly higher than those in the aortic dissection group and pulmonary embolism group, and the differences were statistically significant (all P<0.05). There was no significant difference in serum CK-MB, cTnI, and MYO levels between the aortic dissection group and pulmonary embolism group (all P>0.05). The sensitivity of CK-MB, cTnI, and MYO in the differential diagnosis of acute chest pain patients with coronary heart disease and non-coronary heart disease were 93.33%, 85.33%, and 89.33%, respectively, and the specificity were 73.33%, 80.00%, and 77.78%, respectively. The areas under the receiver operating characteristic (ROC) curve were 0.833, 0.826, and 0.836, respectively. Conclusions:MSCT can better identify coronary heart disease, aortic dissection, and pulmonary embolism in patients with acute chest pain, while the three myocardial markers can better distinguish patients with coronary heart disease and non-coronary heart disease. Therefore, MSCT combined with myocardial markers should be used for the diagnosis of acute chest pain patients in clinical practice to facilitate early clinical diagnosis.

Objective:To systematically review the effect of fracture liaison service (FLS) in elderly patients with fragile hip fractures, so as to provide reference for clinical decision-making.Methods:By combining subject terms and free terms, electronic searches were conducted on China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science. The included references were manually retrieved using the snowball method. The retrieval time was from the establishment of the database to March 1, 2023. Two researchers screened articles based on inclusion and exclusion criteria, extracted data, and evaluated the quality of articles, using RevMan5.4 software for statistical analysis.Results:A total of 15 articles were included, totaling 4 333 patients with fragile hip fractures, with a follow-up time of ≥3 months. Meta-analysis showed that FLS could improve patient medication compliance [ RR=2.32, 95% CI (1.74, 3.11) , P<0.01] and hip function [ SMD=1.20, 95% CI (0.93, 1.47) , P<0.01] , reduce mortality [ RR=0.70, 95% CI (0.58, 0.84) , P<0.01] and the occurrence of refractures [ RR=0.44, 95% CI (0.32, 0.61) , P<0.01] , with statistical differences. Conclusions:Compared with routine nursing for fragile hip fractures, FLS can improve medication compliance and hip function, decrease mortality and the occurrence of refractures in patients with fragile hip fractures.

Humans ; Gastrointestinal Microbiome ; Diabetes Mellitus, Type 2/complications* ; Cholelithiasis

Objective:To analyze the status quo, trend and influencing factors of patient satisfaction in tertiary maternity and child hospitals in China.Methods:Based on the survey results of five round third-party evaluations of the China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on the satisfaction index in tertiary maternity and child hospitals, and the influencing factors of satisfaction were analyzed based on the results of the fifth evaluation.Results:Compared with the first round, the overall patient satisfaction in tertiary maternity and child hospitals in the fifth round was improved(inpatient: from 95.7% to 98.0%; outpatient: from 87.8% to 94.9%). Outpatient satisfaction varied significantly among gender, hospitals of different types, education level, types of treatment, medical insurance and doctors′ titles( P<0.05). Outpatient satisfaction in local hospitals was 1.502 times higher than that in hospitals under the National Health Commission. The satisfaction of referrals was 0.259 times lower than that of patients who were admitted directly. Inpatient satisfaction varied significantly among department, hospitals of different regions, household registration type and whether the admission was delayed due to the COVID-19 epidemic( P<0.05). The satisfaction of inpatients in medical ward and surgical ward was respectively 0.202 and 0.298 times lower than that of inpatients in pediatric ward. Inpatient satisfaction at the central regions was 3.311 times higher than that at the eastern regions. Conclusions:The overall patient satisfaction in tertiary maternity and child hospitals in China is improving. In the future, we should pay more attention to the hospital environment, humanistic care and other non-medical service dimensions with low satisfaction, so as to further improve the medical experience of patients in maternity and child hospitals.