OBJECTIVE To prepare an intelligent responsive liposome-hydrogel nanopreparation co-loaded with gambogic acid （GA）， and characterize its antitumor activity in vitro . METHODS GA-ICG-Lip-gel was prepared by ethanol injection and cold dissolution， incorporating GA and the photosensitizer indocyanine green （ICG）. The appearance and microscopic morphology of GA-ICG-Lip-gel were observed， its encapsulation efficiency and drug loading capacity were measured， and its photothermal conversion performance， photothermal stability， and infrared imaging properties were investigated， along with the determination of its in vitro release profile. Human breast cancer MCF-7 cells were used as objects to investigate the effects of GA-ICG-Lip-gel （or with near-infrared light irradiation） on cell viability， migration ability， and the cellular uptake capacity of GA-ICG-Lip-gel. RESULTS GA-ICG-Lip-gel existed in a solution state at room temperature and transformed into a gel state at 37 ℃. Its microstructure was dense with small pores， and its encapsulation efficiency and drug loading were （96.07±0.86） % and （6.28±1.16） %， respectively. After exposure to near-infrared light， the temperature of GA-ICG-Lip-gel rose above 42 ℃， with no significant attenuation observed in the heating curve. The heating efficiency was dependent on both the irradiation time and drug concentration. Compared to media without gelatinase， the cumulative release rate of GA-ICG-Lip-gel increased in media containing gelatinase. In vitro studies showed that GA-ICG-Lip-gel could be efficiently taken up by MCF-7 cells； GA-ICG-Lip-gel significantly inhibited the viability and migration ability of MCF-7 cells （ P ＜0.05）， and this inhibitory effect was further enhanced under near-infrared light irradiation. CONCLUSIONS This study successfully prepares GA-ICG-Lip-gel， which exhibits favorable photothermal conversion properties and temperature/enzyme dual-responsive drug release characteristics， and demonstrates significant inhibitory effects on the proliferation and migration of breast cancer cells.

OBJECTIVE To establish the graded management standards for off-label use of Shenqi fuzheng injection. METHODS Systematic searches were conducted in databases including CNKI， PubMed and the Cochrane Library to retrieve guidelines/consensuses， systematic reviews/meta-analyses， and randomized controlled trials （RCTs） of Shenqi fuzheng injection. The quality of evidence was evaluated using AGREE Ⅱ， AMSTAR Ⅱ， and the Risk of Bias 1.0 tool recommended by Cochrane Collaboration， and the graded management standard for off-label use of Shenqi fuzheng injection was developed by using the Thomson grading system. RESULTS A total of 534 articles were involved， including 11 guidelines， 22 systematic reviews/meta-analysis， and 501 RCTs. They covered 79 off-label indications for Shenqi fuzheng injection： cancer-related fatigue， colorectal cancer and breast cancer， all with high-quality evidence were classified under grade A management （grade Ⅰ commendation）， allowing all physicians across the hospital to prescribe relevant treatments； five diseases， such as ovarian cancer， liver cancer， leukemia， heart failure and cerebral infarction， were classified under grade B management （grade Ⅱa commendation）， with prescription restricted to physicians with intermediate or higher professional titles in specific departments； eleven diseases， including sepsis， cervical cancer， esophageal cancer， etc.， were classified under grade C management （grade Ⅱb commendation）， requiring strict evaluation by senior physicians before prescription； the use of Shenqi fuzheng injection for other conditions was explicitly prohibited due to a lack of sufficient evidence. CONCLUSIONS Off-label use of Shenqi fuzheng injection is prevalent. The graded management standard established by evidence-based medical approach provides a scientific basis for standardizing the clinical application of traditional Chinese medicine injections and offers an operable paradigm for implementing differentiated drug use supervision in medical institutions.

Objective To explore the correlation between the pathogenesis of toxins damaging liver collateral and the incidence of type 2 diabetes mellitus(T2DM)based on the theory of five circuits and six qi.Methods A total of 986 patients with T2DM treated in the Department of Endocrinology and Metabolism at the Affiliated Hospital of Changchun University of Chinese Medicine from February 2019 to October 2023 were selected as the study subjects.The influences of circuit and qi indicators in the theory of five circuits and six qi on the constitutional characteristics of T2DM patients and the role of pathogenesis of toxins damaging liver collateral in the incidence of T2DM were investigated.Results(1)The five-circuit and six-qi analysis showed that the yearly circuit and sitian/zaiquan conditions had no significant effect on the constitutional characteristics of patients with T2DM(P＞0.05).However,dominant circuit,guest circuit,dominant qi and guest qi significantly influenced the constitutional characteristics of patients with T2DM(P＜0.05).For the distribution of circuit-qi indicators at birth among the 986 patients,dominant circuit was predominated by the terminal circuit of taiyang cold-water,guest circuit was characterized by deficient wood circuit or excessive water circuit,dominant qi was predominated by yangming dry-metal,and guest qi was characterized by taiyin damp-earth.(2)The correlation between the pathogenesis of toxins damaging liver collateral and the incidence of T2DM through comparative analysis revealed that the conveying and dispersing function of the liver plays a leading role in maintaining the body's yin-yang balance and ensuring free movement of qi,indicating that the critical role of toxins damaging liver collateral is the key to the incidence of diabetes.Conclusion Circuit-qi indicators have a certain influence on the constitutional characteristics of T2DM patients.The circuit-qi features at birth of the individuals prone to T2DM are as follows:dominant circuit predominated by the terminal circuit of taiyang cold-water,guest circuit characterized by deficient wood circuit or excessive water circuit,dominant qi being yangming dry-metal,and guest qi being taiyin damp-earth.Pathogenesis of toxins damaging liver collateral is closely related to the incidence of T2DM.Therefore,in treatment,the regulatory role of the liver should be emphasized,and liver-soothing herbs should be used based on syndrome differentiation,aiming for holistic treatment of the physique and the spirit and enhancing the therapeutic efficacy.The exploration will provide a new perspective and approach for the treatment of T2DM.

Objective With the increase in pet-owning households in China, veterinary clinics have increased at an annual rate of 19.86%. However, the management blind area that may exist in multi-department supervision has led to a significantly worse working environment of radiation workers in veterinary clinics than that of medical institutions. The purpose of this study was to understand the levels of occupational external exposure of radiation workers in veterinary clinics in China, analyze the occupational risks faced by radiation workers in veterinary clinics, contribute to the protection of the occupational health of radiation workers, and provide data and scientific basis for the formulation of national relevant regulations and standards. Methods The individual dose monitoring data of radiation workers in selected veterinary clinics in 2022 were obtained from the National Individual Dose Registration System. Results This study involved 1868 radiation workers from 1216 veterinary clinics in 28 provinces and municipalities in China. The maximum annual effective dose was 8.93 mSv, the annual collective dose was 536.77 man·mSv, the average annual effective dose was 0.29 mSv, and the median was 0.15 mSv. The largest proportion of individuals (94.5%) received a dose of less than 1.0 mSv, while 5.4% had doses ranging from 1.0 mSv to less than 5.0 mSv. For radiation workers with an annual effective dose of 1.0 mSv and above, the individual distribution ratio of radiation workers in veterinary clinics was significantly higher compared with those in medical institutions and industrial applications (P < 0.05). Conclusion The levels of occupational external exposure of radiation workers in veterinary clinics meet the requirements of national standards. However, attention should still be paid to the radiation protection of radiation workers in veterinary clinics. This includes enhancing the responsibility awareness of veterinary clinic owners, strengthening protection training for radiation workers, protecting the occupational health of practitioners, and preventing the occurrence of occupational radiation diseases.

Objective:To analyze the influencing factors of skull base reconstruction failure after endoscopic endonasal skull base surgery (EESBS).Methods:A retrospective analysis was performed on 228 EESBS cases at the Affiliated Hospital of Qingdao University from 2018 to 2023. The clinical features associated with skull base reconstruction and postoperative cerebrospinal fluid leakage were collected and analyzed. Lasso regression was initially used for exploratory analysis, and risk factors for reconstruction failure were subsequently evaluated using multifactorial logistic regression.Results:A total of 157 cases of EESBS were included, with an overall reconstruction failure rate of 11.5% (18/157). No patients who underwent second-stage reconstruction with a tipped mucosal flap or multilayered free mucosal and fascial repair experienced further postoperative cerebrospinal fluid leakage. Variables identified through Lasso regression included history of surgery, history of radiotherapy, and site of leakage. Multifactorial logistic analysis showed that history of radiotherapy ( OR=5.96, P=0.021) and site of leakage in the posterior skull base ( OR=8.70, P=0.003) were significant risk factors for failure of skull base reconstruction. Conclusion:In cases with a history of radiotherapy and/or posterior skull base lesions in the operative area, reconstruction strategies should be strengthened to improve the success rate of one-stage repair, in particular, when intraoperative cerebrospinal fluid leakage occurs.

Objective To prepare and characterize the mouse polyclonal antibody against the dense granule protein 24 (GRA24) of Toxoplasma gondii, and explore its preliminary applications. Methods The GRA24 coding sequences of different T. gondii strains were aligned using the MEGA-X software, and the dominant peptide of the GRA24 protein was analyzed with the Protean software. The base sequence encoding this peptide was amplified using PCR assay and ligated into the pET-28a vector, and the generated GRA24 truncated protein was transformed into Escherichia coli BL21. After induction by isopropyl-beta-D-thiogalactopyranoside (IPTG), the expression and purification of the recombinant GRA24 protein was analyzed using sodium dodecyl sulfate - polyacrylamide gel electrophoresis (SDS-PAGE). BALB/c mice were immunized by subcutaneous injection with the purified recombinant GRA24 truncated protein to generate the polyclonal antibody, and the titer of the polyclonal antibody was measured using enzyme linked immunosorbent assay (ELISA). The specificity of the polyclonal antibody was tested using Western blotting, and the intracellular localization of the polyclonal antibody was investigated using immunofluorescence assay (IFA). Results SDS-PAGE showed successful construction of the recombinant expression plasmid, and Coomassie brilliant blue staining showed the generation of the high-purity recombinant GRA24 truncated protein. ELISA measured that the titer of the polyclonal antibody against the GRA24 truncated protein was higher than 1:208 400, and Western blotting showed that the polyclonal antibody was effective to recognize the endogenous GRA24 proteins of different T. gondii strains and specifically recognize the recombinant GRA24 truncated protein. Indirect IFA showed that the GRA24 protein secreted 16 hour following T. gondii invasion in host cells. Conclusions The polyclonal antibody against the T. gondii GRA24 protein has been successfully prepared, which has a widespread applicability, high titers and a high specificity. This polyclonal antibody is available for Western blotting and IFA, which provides the basis for investigating the function of the GRA24 protein.

Objective To explore the characteristic categories of presenteeism among ICU nurses and analyse the influencing factor.Methods A convenience sampling method was adopted to select 391 ICU nurses as the study subjects from four Grade IIIA hospitals in Zhejiang Province in May 2023.A general information questionnaire,the Stanford presenteeism scale-6,and Maslach burnout inventor were used in the survey.R language was used for latent profile analysis,and univariate analysis and multinomial logistic regression analysis were employed to explore the influencing factors of the latent profiles.Results A total of 391 ICU nurses completed the survey,with the score of presenteeism at 16.10±4.64,which was at medium level.The score of presenteeism was further divided into four latent classes:low work limitation-low work energy type accounted for 13.04%,high work limitation-moderate work energy type accounted for 24.55%,low work limitation-high work energy type accounted for 4.86%,moderate work limitation-moderate work energy type accounted for 57.55%.The influencing factors include average monthly income,the score of emotional exhaustion and personal fulfillment dimensions in job burnout(all P<0.05).Conclusion The incidence of presenteeism among the ICU nurses has distinctive classification characteristics.Based on the identified influencing factors,nursing managers should provide individualised interventions to the ICU nurses with different latent profiles of characteristic categories to reduce the presenteeism among the nurses and thereby to improve the quality of nursing services.

Objective To compare the effects of SARIMA,LSTM and EDM in predicting the incidence of HFRS in Weifang under different circumstances,and explore the best prediction model.Methods The monthly incidence of HFRS in Weifang from January 2011 to December 2017 was selected to construct the SARIMA model,univariate LSTM model,univariate EDM model,and SARIMAX model,multivariate LSTM model,and multivariate EDM model including meteorological factors.The monthly incidence from January 2018 to December 2018 was predicted,and the prediction effects of each model were compared.Results The MAPE of SARIMA model,univariate LSTM model,multivariate LSTM model,univariate EDM model,multivariate EDM model were 42.17%,48.40%,16.19%,55.00%,51.79%,respectively.Conclusion The multivariate LSTM model including meteorological factors had a good prediction effect on the incidence of HFRS in Weifang,and the prediction results could provide reference for the prevention and control of HFRS.

Objective:To estimate and analyze the levels of occupational exposure of aircrews in China, and to provide scientific basis for strengthening occupational health management.Methods:Through the FlightAware website, the flight data were collected of a total of 104 routes flying between airports with large passenger volume in China. Four kinds of cosmic radiation dose estimation programs CARI, SIEVERT, PCAIRE, and JISCARD-EX were compared and analyzed from the aspects of covering the number of airports in China, program user experience and example calculation of airline effective dose. Based on route logs, CARI-7A was applied to estimate the levels of occupational exposure of Chinese aircrews to cosmic radiation.Results:The difference in the effective doses calculated by use of these four cosmic radiation dose estimation programs for the routes with different solar activity levels was statistically significant ( M=7.52-180.98, P<0.05). The annual effective dose estimated by PCAIRE for 68 routes from 2014 to 2021 was significantly higher than that estimated by CARI-7A ( Z=2.52, P<0.05). Based on CARI-7A, the annual effective doses from cosmic radiation to aircrews in China from 2014 to 2021 were estimated, being 1.26 (0.57-2.35) mSv for flight attendants and 1.03 (0.47-1.92) mSv for pilots. The effective dose from cosmic radiation to aircrews on a single flight on some high-frequency routes in China ranged from 0.57 to 6.88 μSv. Conclusions:The level of occupational exposure of Chinese aircrews to cosmic radiation meets the requirements of national standards, but is higher than that of occupational exposure from medical and industrial applications of radiation, so it is still necessary to further strengthen the mamagememt of occupational exposure and occupational health of aircrews.

Objective To report single-center experience on CBA combined with LAAC in treat-ment of AF.Methods A retrospective study was conducted on 27 AF patients undergoing one-stop surgery of CBA combined with LAAC in Department of Cardiovascular Diseases of the People's Hospital of Liaoning Provincie from August 2020 to November 2022.The efficacy and safety of the surgery were analyzed.Results There were 22 patients(81.5％)with LAmbre and 5 patients with Watchman(18.5％,including one case of 24 mm Watchman FLX).All the patients achieved complete pulmonary vein isolation,and conversion to sinus rhythm during operation.During a mean follow-up of 30.0±9.2 months,24 patients(88.9％)maintained sinus rhythm at 12-month follow-up,and 22 patients(81.5％)maintained sinus rhythm at 24-month follow-up.TEE at 3 months after operation displayed that all the devices were in good positions and no PDL or DRT was observed.In the 11 patients undergoing cardiac enhanced CT in 12-36 months after surgery,PDL was detected in one patient(9.1％),and uncomplete endothelialisation of the device was observed in another one(9.1％)using the Watchman device.TEE at 26 months revealed one patient(3.7％)of DRT.Conclusion One-stop surgery of CBA combined with LAAC is a feasible treatment option for patients with NVAF and at high risk of stroke.