AIM To study the chemical constituents from Citri reticulatae Pericarpium Viride and their anti-triple negative breast cancer activities in vitro.METHODS The ethanolic extract of Citri reticulatae Pericarpium Viride was isolated and purified by silica gel,polyamide,MCI,Sephadex LH-20 and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The anti-triple negative breast cancer activities were screened by SRB assay,and their effects on the proliferation of triple negative breast cancer cell lines HCC1806,HCC1937 and MDA-MB-231 in vitro were evaluated.RESULTS Twenty compounds were isolated and identified as nobiletin(1),tangeritin(2),5,4'-dihydroxy-7,8-dimethoxy flavonoid(3),naringenin(4),artemetin(5),5-demethynobiletin(6),3,5,6,7,8,3',4'-pentamethoxy flavonoid(7),5,4'-dihydroxy-3,6,7,8,3'-pentamethoxyflavone(8),xanthomicrol(9),p-hydroxycinnamic acid(10),5,4'-dihydroxy-6,7,8,3'-tetramethoxyflavone(11),pectolinarigenin(12),4'-dihydroxy-5,6,7-tetramethoxyflavone(13),hispidulin(14),4',5,6,7-tetramethoxy-flavone(15),1-methyl-4-(prop-1-en-2-yl)cyclohexane-1,2-diol(16),umbelliferone(17),5-hydroxymethyl furfural(18),hydroquinone(19),1H-indole-3-carbaldehyde(20).Compound 8 showed a significant inhibitory effect with the IC50 value of(5.36±0.24)μmol/L on HCC1806 cells.CONCLUSION Compound 20 is isolated from genus Citrus for the first time,8,12-13,16-17 are isolated from this plant for the first time.Compound 8 show inhibitory effects on the proliferation of HCC1806,HCC1937 and MDA-MB-231 cells in vitro and have the strongest activities.Compounds 3-4,11-12,15,17 and 19 show strong inhibitory effect on HCC1806 cells.Compounds 15,19 also inhibit the proliferation of HCC1937 cells in vitro.

Objective:To explore the application effect of virtual reality technology in preoperative anxiety of patients with hand trauma, aiming to improve the negative psychological state of patients before surgery.Methods:A prospective non-randomized controlled trial was conducted. A convenience sampling method was used to select 116 patients with hand trauma who underwent surgical treatment at Wuxi Ninth People′s Hospital from January 2022 to December 2023 as the research subjects. They were divided into an intervention group and a control group according to the treatment time, with 58 cases in each group. The control group received routine nursing intervention, while the intervention group received nursing intervention based on virtual reality technology in addition to the routine care. The preoperative anxiety, uncertainty of illness and subjective well-being of the two groups were compared before and after the intervention.Results:Three cases dropped out in the control group and six in the intervention group, with 55 and 52 patients completing the study in the control and intervention groups, respectively. In the control group, there were 29 males and 26 females, with an age of (40.60 ± 2.09) years. In the intervention group, there were 32 males and 20 females, with an age of (41.27 ± 10.55) years. After the intervention, the scores of the Self-Rating Anxiety Scale and the Uncertainty in Illness Scale in the intervention group were 52.81 ± 5.47 and 62.87 ± 4.26, respectively, which were lower than those in the control group 58.20 ± 7.29 and 67.41 ± 4.15, with statistically significant differences ( t=-4.31, -5.60, both P<0.05). The Index Well-Being score of the intervention group was 7.17 ± 1.15, higher than that of the control group 6.09 ± 0.57, with a statistically significant difference ( t=6.19, P<0.05). Conclusions:Virtual reality technology can effectively alleviate preoperative anxiety, reduce the uncertainty of illness and enhance subjective well-being in patients with hand trauma, which is beneficial to the physical and mental health of patients.

Objective:To investigate effect of esketamine combined with ultrasound-guided stellate ganglion block(SGB)on stress response and postoperative immune function in elderly patients undergoing colorectal resection.Methods:A retrospective analy-sis was conducted in clinical data from 70 cases of elderly patients undergoing elective colorectal resection in Xuzhou Hospital of Tradi-tional Chinese Medicine,Nanjing University of Chinese Medicine from September 2020 to April 2022,who were randomly divided into observation group(n=35)and control group(n=35),control group was treated with ultrasound-guided SGB,observation group was treated with esketamine combined ultrasound-guided SGB.Heart rate(HR),mean arterial pressure(MAP),product of heart rate and systolic blood pressure(RPP)and stress response levels[cortisol(CORT),SOD,MDA,IL-6,TNF-α,IL-1β]were compared between two groups at 5 min before SGB(t0),immediately after tracheal intubation(t1),1 h after operation(t2)and end of operation(t3).CD3+T,CD4+T,CD8+T and CD4+T/CD8+T at t0,t3,24 h after operation(t4)and 72 h after operation(t5)were compared,respec-tively.Recovery time,first exhaust time,bowel sound recovery time and first oral feeding time and incidence of adverse reactions during anesthesia were compared between two groups.Results:HR,MAP,RPP,CORT,SOD,MDA,IL-6,TNF-α,IL-1β,CD3+T,CD4+T,CD8+T and CD4+T/CD8+T at different time points in two groups were compared by repeated measures analysis of variance,and there were significant differences between groups and at different time points(P<0.05).Compared with control group,observation group had shorter recovery time,first exhaust time,bowel sound recovery time,first oral feeding time,postoperative time out of bed(P<0.05),and less intraoperative pain medication consumption,incidence of adverse reactions during anesthesia was reduced[48.57%(17/35)vs 25.71%(9/35),P<0.05].Conclusion:Esketamine combined with ultrasound-guided SGB in elderly patients undergoing enterectomy can promote recovery of postoperative gastrointestinal function,reduce perioperative stress response,has little impact on immune function of patients,reduce perioperative adverse reactions.

Objective Exploring the effect of Bian-stone-based herbal heat therapy on herbal heat ironing in gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients.Methods Convenience sampling method was used to select 68 cases of hematopoietic stem cell transplantation patients who attended the hematology department of a tertiary-level Chinese medicine hospital in Hangzhou from October 2023 to April 2024 as the study subjects,and the SPSS 26.0 statistical software was used to generate a random number for grouping into an experimental and a control group,with 34 cases in each group.On the basis of intravenous antiemetic medication and routine,the experimental group implemented the Bian-stone-based herbal heat therapy on the basis of intravenous antiemetic medication and conventional nursing care.In the control group,intravenous antiemetic drugs and routine care were used,and the intervention duration of both groups was 14 d,of which 7 d was a course of treatment,with a total of 2 courses of treatment.The incidence of gastroin-testinal reactions,Gastrointestinal Symptom Rating Scale(GSRS)score,Pepsin Ⅰ(PG Ⅰ),Pepsin Ⅱ(PG Ⅱ),and the ratio of PG Ⅰ to PG Ⅱ(PGR)before and after the intervention were compared between the 2 groups.Results The final sample of 66 cases was collected in this study,and 1 patient was dislodged from each of the control group and the experimental group.The comparison of the incidence of gastrointestinal reactions between the 2 groups within 14 days showed that the incidences of nausea,vomiting,abdominal distension,and diarrhea were lower in the experimental group than those in the control group(P＜0.05).GSRS scores on days 1,8,and 14 of intervention were compared,and there were effects between groups in both groups(F=5.338,P=0.017).The levels of PG Ⅰ,PG Ⅱ in the experimental group on day 8 of the intervention were lower than those in the control group.The levels of PGR was higher than that in the control group(all P＜0.05).The safety of the 2 groups after treatment was evaluated,and the results showed that no serious adverse events occurred in the 2 groups.Conclusion Bian-stone-based herbal heat therapy can improve gastrointestinal reactions and reduce the incidence of gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients,which provides clinical guidance for the application of Bian-stone-based herbal heat therapy by nursing staff in the future.

AIM To study the chemical constituents from Citri reticulatae Pericarpium Viride and their anti-triple negative breast cancer activities in vitro.METHODS The ethanolic extract of Citri reticulatae Pericarpium Viride was isolated and purified by silica gel,polyamide,MCI,Sephadex LH-20 and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The anti-triple negative breast cancer activities were screened by SRB assay,and their effects on the proliferation of triple negative breast cancer cell lines HCC1806,HCC1937 and MDA-MB-231 in vitro were evaluated.RESULTS Twenty compounds were isolated and identified as nobiletin(1),tangeritin(2),5,4'-dihydroxy-7,8-dimethoxy flavonoid(3),naringenin(4),artemetin(5),5-demethynobiletin(6),3,5,6,7,8,3',4'-pentamethoxy flavonoid(7),5,4'-dihydroxy-3,6,7,8,3'-pentamethoxyflavone(8),xanthomicrol(9),p-hydroxycinnamic acid(10),5,4'-dihydroxy-6,7,8,3'-tetramethoxyflavone(11),pectolinarigenin(12),4'-dihydroxy-5,6,7-tetramethoxyflavone(13),hispidulin(14),4',5,6,7-tetramethoxy-flavone(15),1-methyl-4-(prop-1-en-2-yl)cyclohexane-1,2-diol(16),umbelliferone(17),5-hydroxymethyl furfural(18),hydroquinone(19),1H-indole-3-carbaldehyde(20).Compound 8 showed a significant inhibitory effect with the IC50 value of(5.36±0.24)μmol/L on HCC1806 cells.CONCLUSION Compound 20 is isolated from genus Citrus for the first time,8,12-13,16-17 are isolated from this plant for the first time.Compound 8 show inhibitory effects on the proliferation of HCC1806,HCC1937 and MDA-MB-231 cells in vitro and have the strongest activities.Compounds 3-4,11-12,15,17 and 19 show strong inhibitory effect on HCC1806 cells.Compounds 15,19 also inhibit the proliferation of HCC1937 cells in vitro.

Objective Exploring the effect of Bian-stone-based herbal heat therapy on herbal heat ironing in gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients.Methods Convenience sampling method was used to select 68 cases of hematopoietic stem cell transplantation patients who attended the hematology department of a tertiary-level Chinese medicine hospital in Hangzhou from October 2023 to April 2024 as the study subjects,and the SPSS 26.0 statistical software was used to generate a random number for grouping into an experimental and a control group,with 34 cases in each group.On the basis of intravenous antiemetic medication and routine,the experimental group implemented the Bian-stone-based herbal heat therapy on the basis of intravenous antiemetic medication and conventional nursing care.In the control group,intravenous antiemetic drugs and routine care were used,and the intervention duration of both groups was 14 d,of which 7 d was a course of treatment,with a total of 2 courses of treatment.The incidence of gastroin-testinal reactions,Gastrointestinal Symptom Rating Scale(GSRS)score,Pepsin Ⅰ(PG Ⅰ),Pepsin Ⅱ(PG Ⅱ),and the ratio of PG Ⅰ to PG Ⅱ(PGR)before and after the intervention were compared between the 2 groups.Results The final sample of 66 cases was collected in this study,and 1 patient was dislodged from each of the control group and the experimental group.The comparison of the incidence of gastrointestinal reactions between the 2 groups within 14 days showed that the incidences of nausea,vomiting,abdominal distension,and diarrhea were lower in the experimental group than those in the control group(P＜0.05).GSRS scores on days 1,8,and 14 of intervention were compared,and there were effects between groups in both groups(F=5.338,P=0.017).The levels of PG Ⅰ,PG Ⅱ in the experimental group on day 8 of the intervention were lower than those in the control group.The levels of PGR was higher than that in the control group(all P＜0.05).The safety of the 2 groups after treatment was evaluated,and the results showed that no serious adverse events occurred in the 2 groups.Conclusion Bian-stone-based herbal heat therapy can improve gastrointestinal reactions and reduce the incidence of gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients,which provides clinical guidance for the application of Bian-stone-based herbal heat therapy by nursing staff in the future.

Objective To analyze the current situation of adverse event reported by physicians and provide suggestions for improving the quality of hospital adverse event management.Method Descriptive analysis,chi-square analysis,and degree of structure variation analysis method were used to analyze the current status of adverse event reporting and changes in the composition of reporting personnel in a general hospital in Shanghai from 2021 to 2023.Result Physicians are more inclined to choose adverse event types with mild severity and unclear definition for reporting in their daily clinical work.The number of reports from internal medicine physicians is much higher than that from surgeons.There was a statistically significant difference in the proportion of reported physicians with different professional titles from 2021 to 2023(P＜0.05),with only junior professional title physicians having value of structure vaviation＞0,and the highest contribution rate of structure vaviation is 50.03%.Conclusion In order to improve the reporting of adverse events,hospitals should optimize the reporting system as the basis,pay attention to the reporting situation of surgical and platform departments,and focus on strengthening training for physicians with low seniority.

To solve the dilemma of manual quality control time-consuming and labor-intensive,and artificial intelligence technology being difficult to accurately judge in the monitoring of medical record connotation quality control indicators,the case hospital has developed an appropriate data monitoring strategy with the help of information technology.For the timeliness indicators of medical record writing,full monitoring can be carried out by directly collecting data from the electronic medical record system.Nine indicators of non-timeliness indicators can be automatically judged through intelligent linkage with the deduction items of routine medical record supervision.The application of information technology is conducive to improving the efficiency of index monitoring and the quality of data collection,providing data support for the refined management of medical record quality.

Objective:To investigate the enhancement effect of deep progressive reconstruction (DPR) algorithm on image quality and standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in obese patients. Methods:The images of a total of 27 obese patients,who underwent 18F-FDG PET/CT in Affiliated Nanjing Hospital of Nanjing Medical University from September 2023 to May 2024,were retrospectively enrolled. The images of all patients were collected by using uMI 780 PET/CT. Ordered subset expectation maximization (OSEM) iterative algorithm and DPR algorithm were adopted to reconstruct PET images,and measure counting rate of scattering coincidence of PET/CT images,counting rate of true coincidence,noise equivalent counting rate (NECR) and scattering fraction (SF). The quality indicators of PET images included signal-to-noise ratio (SNR),the maximum SUV (SUVmax) of lesions,the tumor-to-background ratio (TBR),the contrast-to-noise ratio (CNR) and the visual scores of 18F-FDG PET/CT images on livers were evaluated. The differences and consistency of various indicators between DPR and OSEM reconstruction algorithms were further analyzed. Results:The average 18F-FDG PET/CT injection activity of 27 patients was (0.12±0.01) mCi (1 mCi=37 MBq)/kg,and the counting rate of true coincidence,NECR and SF of PET images were respectively (153.73±25.09),(44.81±8.47) kcps and (36.77±1.91)％. The SNR of liver obtained by DPR algorithm was (15.83±3.60),which was significantly higher than that (9.06±1.87) of OSEM algorithm,with statistically significant (t=20.6,P<0.05),and there was significantly correlation in liver SNR between two algorithms (R2=0.91,P<0.05). In 27 uptake 18F-FDG PET/CT lesions,the SUVmax,TBR and CNR of lesions that were obtained from OSEM algorithm were respectively (5.86±1.49),(1.95±0.49) and (17.74±4.77),which were lower than corresponding those of DPR algorithm,and the differences were significant (t=9.03,8.79,15.49,P<0.05),respectively. There were significant correlations in SUVmax,TBR and CNR between the two algorithms (R2=0.71,0.70,0.76,P<0.05),respectively. The visual scores of PET images obtained from the DPR algorithm was 4 (3,5) scores,which was significantly higher than 3 (2,4) scores of OSEM algorithm,and the difference of that between two algorithms was significant (U=396,P<0.05). Conclusion:The scattering effect of 18F-FDG PET/CT imaging is stronger in obese patients,whose counting rate of equivalent effect of noise is lower. The DPR reconstruction algorithm can significantly improve the SNR and lesion contrast of PET images than the OSEM algorithm,which has significant gain effect on the SUVmax of lesions,and it can significantly improve the quality of 18F-FDG PET/PET images in obese patients.

Objective To explore the mechanism of Bushen Zhupai Decoction in treating ovarian fibrosis in polycystic ovary syndrome(PCOS)model rats based on IL-17/TRAF6/NF-κB signaling pathway.Methods Totally 60 SPF grade female SD rats were randomly divided into blank group,model group,Yousiyue group and TCM low-,medium-and high-dosage groups,with 10 rats in each group.The PCOS model was replicated by gavage of 1 mg/kg letrozole for 21 days.The Yousiyue group was given a 10 mg/kg solution of drospirenone ethinylestradiol tablets by gavage,TCM low-,medium-and high-dosage groups were given 8.82,17.64 and 35.28 g/kg of Bushen Zhupai Decoction by gavage,once a day for 28 consecutive days.HE and Masson staining were used to observe the morphology of ovarian tissue and ovarian fibrosis,the contents of serum IL-17,IL-18 and IL-1β were detected by ELISA,the mRNA expression of IL-17,TRAF6,NF-κB p65 and TGF-β1 in ovarian tissue were determined by RT-qPCR,the protein expression of TRAF6,NF-κB p65,TGF-β1,α-SMA,E-cadherin and the positive expression of IL-17RA,TRAF6,NF-κB p65,TGF-β1 and α-SMA in ovarian tissue were detected by Western blot and immunohistochemical staining respectively.Results Compared with the blank group,the body mass,ovarian mass and ovarian index significantly increased of rats in model group,with follicular cystic dilation,thinning of granulosa cell layer,and significant increase in fibrosis positive range(P<0.01),the serum contents of IL-17,IL-18 and IL-1β significantly increased(P<0.01),the expressions of IL-17,TRAF6,NF-κB p65,TGF-β1 mRNA and IL-17RA,TRAF6,NF-κB p65,TGF-β1 and α-SMA proteins significantly increased(P<0.01,P<0.05),the expression of E-cadherin protein significantly decreased(P<0.01).Compared with the model group,the ovarian index of rats in Yousiyue group and TCM medium-and high-dosage groups significantly decreased(P<0.01,P<0.05),the rats in TCM high-dosage group showed dominant follicles,increased thickness of granulosa cell layer,and significantly reduced fibrosis positive range(P<0.01),the serum contents of IL-17,IL-18 and IL-1β significantly decreased in Yousiyue group and TCM low-,medium-and high-dosage groups(P<0.01),the mRNA expressions of IL-17,TRAF6,NF-κB p65,TGF-β1,and the protein expressions of IL-17RA,TRAF6,NF-κB p65,TGF-β1 and α-SMA in ovarian tissue significantly decreaed in TCM high-dosage group(P<0.01,P<0.05),the expression of E-cadherin protein significantly increased(P<0.01).Conclusion Bushen Zhupai Decoction can decrease the body mass,improve the ovarian index,decrease the expressions of inflammatory factors and improve the status of ovarian fibrosis in PCOS rats.The mechanism may be related to the regulation of IL-17/TRAF6/NF-κB signaling pathway.