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:In the context of China's cardiovascular disease(CVD)high-risk population screening and intervention project,this study systematically evaluates the applicability of the EQ-5D-5L and SF-6Dv2 instruments among individuals at high risk of CVD.Methods:Convergent validity was assessed using Spearman's correlation coefficient.Measurement agreement was evaluated through intraclass correlation coefficients(ICC)and Bland-Altman plots.Factors influencing utility differences were explored using multiple linear regression analysis.Kruskal-Wallis test and t-test were used to examine discriminant validity.Sensitivity was compared by effect size(ES),relative efficiency(RE),and the area under the receiver operating characteristic curve(ROC-AUC).Floor and ceiling effects were also compared.Results:Among 5,415 individuals at high risk of CVD,the two instruments showed moderate overall correlation and acceptable convergent validity,but dimension-specific correlations were weak,and measurement consistency was low(ICC=0.367).Both instruments effectively distinguished different health states,yet the SF-6Dv2 demonstrated superior sensitivity and a milder ceiling effect.Conclusion:When measuring the health utility value of CVD patients,scale selection should be cautious,especially for high-risk groups,and SF-6Dv2 is more appropriate.

Objective:To observe the clinical effect of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage, so as to promote patient lung rehabilitation, reduce pulmonary complications, and improve prognosis.Methods:Adopting a randomized controlled trial method, a total of 102 patients with cerebral hemorrhage who were hospitalized in the Department of Neurosurgery of The First Hospital of Jiaxing from January 2022 to December 2023 and their caregivers were selected as the research objects by convenience sampling method. The patients were divided into the control group (51 cases) and the observation group (51 cases) by the random number table method. The control group received traditional back tapping on the basis of routine nursing and back tapping guidance. The observation group used a new type of lung body projection flashlight for percussion back to assist in back tapping nursing and health guidance on the basis of routine nursing.The incidence of pulmonary infection, white blood cell count, levels of hypersensitive C-reactive protein and procalcitonin, the quality of discharge guidance, the scores of satisfaction of patients, and the assessment score of caregivers′ percussion back skills were evaluated in the two groups.Results:Finally, a total of 49 patients were enrolled in the observation group, including 38 males and 11 females, aged (67.08 ± 11.05) years old. A total of 49 patients were enrolled in the control group, including 31 males and 18 females, aged (68.84 ± 10.46) years old. There were 8 males and 41 females, aged (58.00 ± 8.17) years old in the caregivers of the observation group. There were 6 males and 43 females, aged (57.57 ± 9.15) years old in the caregivers of the observation group. The incidence of pulmonary infection in the observation group was 28.6% (14/49), which was lower than that in the control group 32.7% (16/49), and the difference was not statistically significant ( P>0.05). There was no significant difference in the level of white blood cell count, hypersensitive C-reactive protein and procalcitonin between the two groups when the time of pulmonary infection was diagnosed and after 2 weeks of treatment ( P>0.05). The levels of white blood cell count, hypersensitive C-reactive protein and procalcitonin after 1 week of treatment were (7.97 ± 1.30)×10 9/L, (30.71 ± 11.96) mg/L, 0.04(0.02, 0.07) μg/L in the observation group, which were all lower than those in the control group (9.46 ± 2.16) × 10 9/L, (58.34 ± 48.96) mg/L, 0.09(0.04, 0.20) μg/L, and the differences were statistically significant ( t=5.06, 4.22, Z=1.98, all P<0.05). The total score of discharge guidance quality, obtained content, guidance skills and effect scores were (134.94 ± 7.34), (47.80 ± 2.86), (87.14 ± 5.98) points in the observation group, which were significantly higher than those in the control group (117.04 ± 7.04), (39.80 ± 3.15), (77.24 ± 5.60) points, and the differences were statistically significant ( t=12.32, 13.15, 8.46, all P<0.05). The scores of the satisfaction of patients including six aspects(operation convenience, precise positioning, goal orientation, operation specification, nursing confidence and mission satisfaction) in the observation group were 91.84%(45/49), 95.92%(47/49), 91.84%(45/49), 93.88%(46/49), 91.84%(45/49), 97.96%(48/49), which were higher than those in the control group 73.47%(36/49), 57.14%(28/49), 53.06%(26/49), 67.35%(33/49), 73.47%(36/49), 81.63%(40/49), and the differences were statistically significant ( χ2 values were 5.76-20.51, all P<0.05). The assessment score of percussion skills of caregivers in the observation group was (79.55 ± 3.98) points, which was significantly higher than that in the control group (75.35 ± 4.94) points, and the difference was statistically significant ( t=4.64, P<0.05). Conclusions:The clinical application of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage can achieve accurate and standardized percussion back to promote the improvement of pulmonary infection and improve the skill level of caregivers of cerebral hemorrhage patients, as well as improve the quality of discharge guidance and the satisfaction of patients.

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.

Aim To identify the underlying target of bullatine A(BA)against rheumatoid arthritis(RA)u-sing limited proteolysis-small molecule mapping(LiP-SMap)drug target proteomics and to provide a scientif-ic basis for clinical application of Aconiti brachypodi Radix in the treatment of RA.Methods LiP-SMap drug target proteomics was employed to perform bioin-formatics analysis for comparing and validating the dif-ferential protein expression after BA intervention.A collagen-induced arthritis(CIA)model was estab-lished in DBA/1 mice using bovine type Ⅱ collagen.The mice were then divided into the CIA model group,methotrexate-positive control group(MTX group),and BA groups(10 mg·kg-1 and 20 mg·kg-1)based on their clinical scores.After drug intervention,the thera-peutic efficacy against RA was assessed by joint index scores and foot thickness measurements.Histopatholog-ical changes in the arthritic joints of CIA mice were e-valuated using hematoxylin and eosin(HE)staining.Enzyme-linked immunosorbent assay(ELISA)was employed to detect inflammatory cytokines interleukin-17(IL-17)and total IgG and IgG3 anti-collagen-spe-cific antibodies levels from the serum of CIA mice.Flow cytometry was used to detect the expression levels of intracellular Th17 cells(IL-17+CD4+T cells)and Th1 cells(IFN-γ+CD4+T cells).Fluorescent quanti-tative PCR was performed to detect the expression of genes related to differential proteins.Results The proteomic analysis identified Serpinb1a as a protein with strong binding affinity to BA,and KEGG enrich-ment analysis indicated IL-17 signaling pathway was a crucial pathway of BA in against RA.BA treatment significantly reduced clinical scores and foot thickness,improved local arthritis symptoms in CIA mice,and al-leviated inflammatory cell infiltration into arthritic joints(P＜0.05).Differential protein validation re-sults showed that BA had strong affinity with Serpinb1a(-5.92 kJ·mol-1)and downregulated the expres-sion of Serpinb1a mRNA.Furthermore,the administra-tion of BA markedly reduced serum IL-17 A levels from CIA mice,inhibited the expression of intracellular IL-17 A and IFN-γ cytokines in splenic CD4+T cells(P＜0.05),and significantly downregulated the transcrip-tional expression of IL-17F(P＜0.05).Conclusion BA exhibits therapeutic effects on collagen-induced arthritis,and its mechanism of action may involve the regulation of Serpinb1a and the IL-17 signaling path-way.

This study was aimed at exploring the interaction between the nucleoprotein(NP)of influenza A virus(IAV)and TRIM25.The physicochemical properties and protein structure of IAV NP protein were analyzed through bioinformatics methods.The interaction between IAV NP and TRIM25 proteins was simulated with molecular docking techniques,and the in-teraction sites were predicted.With the cDNA of the A/Puerto Rico/8/1934(H1N1)PR8 strain as the template,the NP pro-tein was cloned into the eukaryotic expression vector pCMV-C-Flag through PCR amplification,the eukaryotic expression re-combinant plasmid pCMV-Flag-NP was constructed,and the expression was further verified.The protein expression levels of pCMV-Flag-NP and pCMV-HA-TRIM25 were detected at various time periods.The interaction between NP protein and TRIM25 protein was verified by co-immunoprecipitation.The co-localization of NP protein and TRIM25 protein in cells was ob-served with laser confocal microscopy.Bioinformatics analysis revealed that the NP protein consists of 498 amino acids and 20 amino acids,and is an unstable hydrophilic protein.The NP protein has multiple phosphorylation sites,as well as N-glycosyla-tion and O-glycosylation sites,but no transmembrane domain or signal peptide domain.Additionally,the NP protein's second-ary structure consists of a high proportion of alpha-helices and random coils.The molecular docking prediction results indicated that IAV NP interacts with TRIM25 protein and has multiple potential interaction sites,including the 233rd alanine,234th ala-nine,236th lysine,and 440th alanine of the NP protein.After successfully constructing and expressing the IAV NP protein,we verified the interaction between IAV NP and TRIM25 protein by immunoprecipitation and laser confocal microscopy obser-vations.Our results together suggested that the structure of the IAV NP protein is closely related to its function,and its im-portance to the virus is clear.In addition,the interaction between IAV NP and TRIM25 protein may be associated with TRIM25's anti-influenza virus mechanism.Further in-depth research may provide new ideas for anti-influenza virus strategies.

Objective:In the context of China's cardiovascular disease(CVD)high-risk population screening and intervention project,this study systematically evaluates the applicability of the EQ-5D-5L and SF-6Dv2 instruments among individuals at high risk of CVD.Methods:Convergent validity was assessed using Spearman's correlation coefficient.Measurement agreement was evaluated through intraclass correlation coefficients(ICC)and Bland-Altman plots.Factors influencing utility differences were explored using multiple linear regression analysis.Kruskal-Wallis test and t-test were used to examine discriminant validity.Sensitivity was compared by effect size(ES),relative efficiency(RE),and the area under the receiver operating characteristic curve(ROC-AUC).Floor and ceiling effects were also compared.Results:Among 5,415 individuals at high risk of CVD,the two instruments showed moderate overall correlation and acceptable convergent validity,but dimension-specific correlations were weak,and measurement consistency was low(ICC=0.367).Both instruments effectively distinguished different health states,yet the SF-6Dv2 demonstrated superior sensitivity and a milder ceiling effect.Conclusion:When measuring the health utility value of CVD patients,scale selection should be cautious,especially for high-risk groups,and SF-6Dv2 is more appropriate.

Objective:To observe the clinical effect of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage, so as to promote patient lung rehabilitation, reduce pulmonary complications, and improve prognosis.Methods:Adopting a randomized controlled trial method, a total of 102 patients with cerebral hemorrhage who were hospitalized in the Department of Neurosurgery of The First Hospital of Jiaxing from January 2022 to December 2023 and their caregivers were selected as the research objects by convenience sampling method. The patients were divided into the control group (51 cases) and the observation group (51 cases) by the random number table method. The control group received traditional back tapping on the basis of routine nursing and back tapping guidance. The observation group used a new type of lung body projection flashlight for percussion back to assist in back tapping nursing and health guidance on the basis of routine nursing.The incidence of pulmonary infection, white blood cell count, levels of hypersensitive C-reactive protein and procalcitonin, the quality of discharge guidance, the scores of satisfaction of patients, and the assessment score of caregivers′ percussion back skills were evaluated in the two groups.Results:Finally, a total of 49 patients were enrolled in the observation group, including 38 males and 11 females, aged (67.08 ± 11.05) years old. A total of 49 patients were enrolled in the control group, including 31 males and 18 females, aged (68.84 ± 10.46) years old. There were 8 males and 41 females, aged (58.00 ± 8.17) years old in the caregivers of the observation group. There were 6 males and 43 females, aged (57.57 ± 9.15) years old in the caregivers of the observation group. The incidence of pulmonary infection in the observation group was 28.6% (14/49), which was lower than that in the control group 32.7% (16/49), and the difference was not statistically significant ( P>0.05). There was no significant difference in the level of white blood cell count, hypersensitive C-reactive protein and procalcitonin between the two groups when the time of pulmonary infection was diagnosed and after 2 weeks of treatment ( P>0.05). The levels of white blood cell count, hypersensitive C-reactive protein and procalcitonin after 1 week of treatment were (7.97 ± 1.30)×10 9/L, (30.71 ± 11.96) mg/L, 0.04(0.02, 0.07) μg/L in the observation group, which were all lower than those in the control group (9.46 ± 2.16) × 10 9/L, (58.34 ± 48.96) mg/L, 0.09(0.04, 0.20) μg/L, and the differences were statistically significant ( t=5.06, 4.22, Z=1.98, all P<0.05). The total score of discharge guidance quality, obtained content, guidance skills and effect scores were (134.94 ± 7.34), (47.80 ± 2.86), (87.14 ± 5.98) points in the observation group, which were significantly higher than those in the control group (117.04 ± 7.04), (39.80 ± 3.15), (77.24 ± 5.60) points, and the differences were statistically significant ( t=12.32, 13.15, 8.46, all P<0.05). The scores of the satisfaction of patients including six aspects(operation convenience, precise positioning, goal orientation, operation specification, nursing confidence and mission satisfaction) in the observation group were 91.84%(45/49), 95.92%(47/49), 91.84%(45/49), 93.88%(46/49), 91.84%(45/49), 97.96%(48/49), which were higher than those in the control group 73.47%(36/49), 57.14%(28/49), 53.06%(26/49), 67.35%(33/49), 73.47%(36/49), 81.63%(40/49), and the differences were statistically significant ( χ2 values were 5.76-20.51, all P<0.05). The assessment score of percussion skills of caregivers in the observation group was (79.55 ± 3.98) points, which was significantly higher than that in the control group (75.35 ± 4.94) points, and the difference was statistically significant ( t=4.64, P<0.05). Conclusions:The clinical application of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage can achieve accurate and standardized percussion back to promote the improvement of pulmonary infection and improve the skill level of caregivers of cerebral hemorrhage patients, as well as improve the quality of discharge guidance and the satisfaction of patients.

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.