ObjectiveTo investigate the effect and mechanism of Qingre Sanzhuo decoction in treating gouty arthritis （GA） combined with hyperuricaemia （HUA）. MethodsSixty male SD rats were randomized into normal， model， colchicine （0.5 mg·kg^-1）， and low-， medium-， and high-dose （17， 34， 68 g·kg^-1， respectively） Qingre Sanzhuo decoction groups （n=10）. The rats in other groups except the normal group were treated with the modified method for the modeling of GA combined with HUA. The drug intervention groups were administrated with corresponding drugs by gavage in the afternoon every day and the normal group and the model group were administrated with an equal volume of sterile normal saline by gavage. The level of uric acid （SUA） in the serum was measured 2 h after the last administration. The degree of ankle joint swelling was calculated 0.5， 12， 24， 48 h after modeling， and joint inflammation was scored. The pathological changes of ankle joints were observed by hematoxylin-eosin staining， and the serum levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， C reactive protein （CRP）， and interleukin-18 （IL-18） were measured by enzyme-linked immunosorbent assay. Real-time PCR was performed to determine the mRNA levels of NOD-like receptor protein 3 （NLRP3）， apoptosis-associated speck-like protein containing CARD （ASC）， cysteinyl aspartate-specific protease-1 （Caspase-1）， gasdermin D （GSDMD）， and nuclear factor-kappa B （NF-κB） in the synovial tissue of ankle joints. Western blot was employed to determine the protein levels of NLRP3， ASC， and Caspase-1 in ankle joints. The immunohistochemical method was used to detect the expression of GSDMD and NF-κB in the synovial tissue of ankle joints. ResultsCompared with the normal group， the model group showed increased SUA in the serum （P<0.05）， ankle joint swelling and joint inflammation （P<0.05）， increased number of blood vessels in the synovium， inflammatory cell foci in the synovial bursa， elevated serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and up-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. Compared with the model group， the medium- and high-dose Qingre Sanzhuo decoction groups showed reduced SUA in the serum （P<0.05）， alleviated ankle joint swelling and joint inflammation （P<0.05）， lowered serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and down-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. However， in terms of ameliorating the pathological changes of ankle joints， only the high-dose Qingre Sanzhuo decoction group showed normal morphology of the synovial membrane of ankle joints and no obvious lesion in the articular cartilage. ConclusionQingre Sanzhuo decoction may play a role in preventing and controlling GA combined with HUA by down-regulating the activity of NLRP3/ASC/Caspase-1 pathway and inhibiting the expression of inflammatory cytokines， such as TNF-α， IL-1β， CRP， and IL-18.

Objective To review the research of safe injection protocols for peripheral norepinephrine(pNE),to make clear the main contents of safe injection protocols and the compliance of clinical implementation protocols,and to provide reference for clinical nurses to use drugs safely.Methods Systematic searches were conducted in the PubMed database,the Embase database from the Netherlands,the Web of Science,the Cochrane library,CNKI,Wanfang database,VIP,and the China biomedical literature database for studies related to safe injection protocols for pNE.The search period extended from the establishment of the databases to April 30,2024.Two researchers conducted data extraction and summary analysis of the included literature.Results A total of 10 articles were incorporated,including 2 guidelines,4 observational retrospective cohort studies,2 observational prospective cohort studies,2 ambispective cohort study.All documents provide a complete safe injection scheme of pNE,and its main contents were as follows:the drug concentration should be diluted to 8～64 mg/L;the injection dose should be small,and the maximum dose should not exceed 0.5 μg·kg-1·min-1 or 25 μg/min;a short infusion time was appropriate,among which 4 schemes require≤24 hours;intravenous catheters should be large-bore models,mainly 16,18 and 20 G;selection of infusion sites with favorable venous conditions of upper limb should be selected for injection;during infusion,regular and effective monitoring was required,and the frequency of monitoring should be once an hour,not exceeding a maximum of 2 hours;observation of the puncture site,and must assess whether there was blood return to the venous pathway,develop an emergency plan for drug extravasation.Several studies provided the compliance analysis of the protocol.The items with the highest compliance were using the drug concentration specified in the protocol,with the highest implementation rate of 100.0%.The items with low compliance were:using ultrasonic catheterization or evaluation,with minimum 26.6%;monitor according to the specified time frequency,with a minimum of 36.0%;selection of infusion sites,with a minimum of 65.0%.Conclusion The pNE is safe and feasible in emergency situations,but it comes with numerous risks and limitations.Norepinephrine(NE)should be administered at low concentrations and small doses,using large-caliber venous indwelling needles,and choosing optimal injection sites.Ultrasound assessment and localization can be used if conditions permit.Short-term infusion is preferred,and effective monitoring should be conducted at regular intervals during the infusion.Emergency plans for drug extravasation should be established.Developing safe injection protocols can reduce the incidence of adverse events such as extravasation.

Objective To review the research of safe injection protocols for peripheral norepinephrine(pNE),to make clear the main contents of safe injection protocols and the compliance of clinical implementation protocols,and to provide reference for clinical nurses to use drugs safely.Methods Systematic searches were conducted in the PubMed database,the Embase database from the Netherlands,the Web of Science,the Cochrane library,CNKI,Wanfang database,VIP,and the China biomedical literature database for studies related to safe injection protocols for pNE.The search period extended from the establishment of the databases to April 30,2024.Two researchers conducted data extraction and summary analysis of the included literature.Results A total of 10 articles were incorporated,including 2 guidelines,4 observational retrospective cohort studies,2 observational prospective cohort studies,2 ambispective cohort study.All documents provide a complete safe injection scheme of pNE,and its main contents were as follows:the drug concentration should be diluted to 8～64 mg/L;the injection dose should be small,and the maximum dose should not exceed 0.5 μg·kg-1·min-1 or 25 μg/min;a short infusion time was appropriate,among which 4 schemes require≤24 hours;intravenous catheters should be large-bore models,mainly 16,18 and 20 G;selection of infusion sites with favorable venous conditions of upper limb should be selected for injection;during infusion,regular and effective monitoring was required,and the frequency of monitoring should be once an hour,not exceeding a maximum of 2 hours;observation of the puncture site,and must assess whether there was blood return to the venous pathway,develop an emergency plan for drug extravasation.Several studies provided the compliance analysis of the protocol.The items with the highest compliance were using the drug concentration specified in the protocol,with the highest implementation rate of 100.0%.The items with low compliance were:using ultrasonic catheterization or evaluation,with minimum 26.6%;monitor according to the specified time frequency,with a minimum of 36.0%;selection of infusion sites,with a minimum of 65.0%.Conclusion The pNE is safe and feasible in emergency situations,but it comes with numerous risks and limitations.Norepinephrine(NE)should be administered at low concentrations and small doses,using large-caliber venous indwelling needles,and choosing optimal injection sites.Ultrasound assessment and localization can be used if conditions permit.Short-term infusion is preferred,and effective monitoring should be conducted at regular intervals during the infusion.Emergency plans for drug extravasation should be established.Developing safe injection protocols can reduce the incidence of adverse events such as extravasation.

ObjectiveTo investigate the use of contraceptive methods， and to evaluate maternal healthcare services utilization among women within 2 years in Pudong New Area of Shanghai. MethodsA cross-sectional survey was conducted using a questionnaire for women at different postpartum periods who visited a community health clinic with their children from June to November 2021. Data were analyzed using χ² test and binary logistic regression. ResultsAmong the 1 946 postpartum women surveyed， 1 934 were either married or cohabiting， and1 430 had resumed their sexual life. Among women at 4， 6， 12， 18 and 24 months postpartum， the contraceptive prevalence rates （CPR） were 92.34% （193/209）， 92.16% （235/255）， 87.31% （282/323）， 91.95% （297/323） and 90.00% （288/320）， respectively. The modern contraceptive prevalence rates （mCPR） were 87.08% （182/209）， 87.06% （222/255）， 82.04% （265/323）， 83.09% （271/323） and 85.31% （273/320）， respectively， while the unmet contraceptive needs （UMNs） were 7.66% （16/209）， 7.84% （20/255）， 11.46% （37/323）， 6.81% （22/323） and 10.00% （32/320）， respectively. The use rates of long-acting reversible contraceptive （LARC） methods among women at 6， 12， 18 and 24 months postpartum period were 0.39% （1/255）， 2.17% （7/323）， 0.31% （1/323）， and 2.81% （9/320）， respectively. Among all surveyed subjects， 32.17% （626/1 946） had received postpartum contraceptive services only once， while 27.85% （542/1 946） had not received any postpartum contraceptive services. Binary logistic regression analysis indicated that the use of contraceptive methods among postpartum women was associated with whether relevant educational services were received after childbirth and during postpartum home visits （all P<0.05）. ConclusionPostpartum women have unmet needs for contraception. Contraceptive guidance at the 42-day postnatal healthcare visit needs to be further strengthened and postpartum contraceptive education could be integrated into the pregnancy care. The quality and effectiveness of contraceptive education during delivery and postpartum home visits， and even at the 42-day postnatal healthcare visit need to be further explored.

BACKGROUND:The results of in vivo and in vitro studies showed that catalpol from Rehmannia glutinosa can significantly reduce the level of inflammatory indexes in the synovial tissue of rats with knee osteoarthritis,and meanwhile,it can delay the progression of knee osteoarthritis.But whether catalpol from Rehmannia glutinosa affects chondrocyte senescence and then delay the progression of knee osteoarthritis has not yet been clarified. OBJECTIVE:To investigate investigate whether catalpol from Rehmannia glutinosa could regulate ATDC5 chondrocyte senescence and the possible mechanisms. METHODS:ATDC5 chondrocytes were divided into blank group(0.1%bovine serum albumin),model group(0.1%bovine serum albumin+1 μmol/L adriamycin),low-dose catalpol group(0.1%bovine serum albumin+1 μmol/L adriamycin+20 μmol/L catalpol from Rehmannia glutinosa)and high-dose catalpol group(0.1%bovine serum albumin+1 μmol/L adriamycin+80 μmol/L catalpol from Rehmannia glutinosa).Adriamycin-induced ATDC5 chondrocyte senescence model was constructed,and the corresponding treatments were given according to the above groups.Cell counting kit-8 assay was used to detect the effects of catalpol from Rehmannia glutinosa on ATDC5 chondrocyte viability,and to screen the optimal concentration of catalpol from Rehmannia glutinosa.The senescence of ATDC5 chondrocytes in each group was detected by β-galactosidase staining after the corresponding treatments.Real-time fluorescence quantitative PCR and western blot were used to detect the mRNA and protein expression of P21,P53,type II collagen,matrix metalloproteinase 13,and interleukin-6.Immunofluorescence method was used to detect the expression of P21,P53 and type II collagen.Flow cytometry was used to detect apoptosis in each group. RESULTS AND CONCLUSION:ATDC5 chondrocytes were identified to be successfully induced and senescence model was induced.Catalpol from Rehmannia glutinosa at the concentrations of 0,20,40,and 80 μmol/L showed no significant effects on the cell viability,suggesting that catalpol from Rehmannia glutinosa is non-cytotoxic and can be used safely(P>0.05);when the concentration was≥100 μmol/L,the cell viability was reduced,suggesting that there may be cytotoxic.Therefore,80 μmol/L was chosen as the high dose for subsequent experiments in this study.The percentage of positive cells in the model group was(86.93±2.18)%,which was significantly higher than that in the blank group[(17.32±0.72)%;P<0.05].Compared with the model group,the percentage of positive cells was significantly lower in the low-and high-dose catalpol groups[(57.28±1.73)%and(27.18±0.97)%,respectively;both P<0.05].Compared with the model group,the relative expression of P21,P53,matrix metalloproteinase 13,and interleukin-6 at mRNA and protein levels was significantly downregulated in the low-and high-dose catalpol groups,while the relative expression of type II collagen at mRNA and protein levels was significantly upregulated in both groups(P<0.05),especially in the high-dose catalpol group(P<0.05).Compared with the model group,the fluorescence intensities of P21 and P53 were significantly weakened in the low-and high-dose catalpol groups,while the fluorescence intensity of type II collagen was significantly enhanced in the low-and high-dose catalpol groups(P<0.05),especially in the high-dose catalpol group(P<0.05).The cell apoptosis detected by Annexin V/PI method showed that there was no significant difference between the model group and the blank group(P>0.05);compared with the model group,the apoptotic index was significantly elevated in the low-and high-dose catalpol groups,especially in the high-dose catalpol group(P<0.05).To conclude,catalpol from Rehmannia glutinosa can slow the progression of osteoarthritis by promoting apoptosis of senescent ATDC5 chondrocytes,further removing senescent ATDC5 chondrocytes,and decreasing the senescence-associated phenotypes.

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in assessing thrombus of inferior vena cava filters before filters removal. Methods We analyzed 127 patients who scheduled for inferior vena cava filter extraction from June to November 2023, 53 of which underwent CEUS examination. The enhancement of contrast agent signal within and around the filter was observed under CEUS mode. The thrombus was classified based on the signal loss of contrast agent and then compared with digital subtraction angiography(DSA). Results In the CEUS mode, the contrast agent was visualized within the inferior vena cava, clearly revealing signal loss for the thrombus location. Based on the size and location of the thrombus, filter thrombus was categorized into four groups: 41 cases of type 0, 8 cases of type Ⅰ, 3 cases of type Ⅱ, and 1 case of type Ⅲ. No significant difference in thrombus classification was observed between CEUS and DSA (P>0.05). According to the classification of filter thrombus, different extraction schemes were applied to 53 patients with inferior vena cava filters. There were no major bleeding events or symptomatic pulmonary embolism happened. Conclusions CEUS is valuable for evaluating filter thrombus prior to removal, providing a basis for preoperative assessment of surgical risks, selection of treatment plans, and prevention of complications.

Objective:To explore the curative effect of Buyang Huanwu Decoction combined with suspension exercise training for the patients with cerebral infarction combined and lower limb hemiplegia.Methods:According to random number table method, 94 patients with cerebral infarction and lower limb hemiplegia meeting the inclusion criteria were divided into the control group and the observation group between January 2017 and February 2021, 47 in each group. The control group was treated with suspension exercise training, while observation group was additionally treated with Buyang Huanwu Decoction on the basis of the control group treatment. All were treated for 6 weeks and then followed up for 3 months. Before and after treatment, the Traditional Chinese Medicine (TCM) syndromes scores were recorded. The severity of nerve function injury was evaluated by National Institutes of Health Stroke Scale (NIHSS). The lower limb function was evaluated by Fugl-Meyer Assessment (FMA). The balance function was evaluated by Berg Balance Scale (BBS). The activities of daily life were assessed by Barthel Index (BI). The whole blood high shear viscosity, plasma viscosity and hematocrit were detected by full-automatic hemorheology analyzer. The levels of plasma total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) were detected by full-automatic analyzer. All were followed up for 3 months. The prognosis of patients was assessed by modified Rankin scale (mRS). The adverse reactions during treatment were recorded.Results:After treatment, scores of TCM syndromes and NIHSS in observation group were significantly lower than those in control group ( t=5.35, 4.54, P<0.01), while scores of FMA, BBS and BI were significantly higher than those in control group ( t=3.40, 3.10, 7.57, P<0.01). The whole blood high-shear viscosity, plasma viscosity and hematocrit in observation group were significantly lower than those in control group ( t=2.94, 3.81, 4.23, P<0.05 or P<0.01), and levels of TC, TG and LDL-C were significantly lower than those in control group ( t=4.10, 4.27, 3.61, P<0.01). The differences in good prognosis rate between observation group and control group were statistically significant [74.47% (35/47) vs. 51.06% (24/47); χ2=5.51, P=0.019]. Conclusion:The Buyang Huanwu Decoction combined with suspension exercise training can relieve clinical symptoms, recover lower limb function, improve activities of daily life and prognosis in cerebral infarction combined with lower limb hemiplegia.

Objective:To understand the knowledge, attitude and practice of edema in patients with critically illness of ICU nurses, and to analyze its influencing factors.Methods:After developing the Knowledge-Attitude-Practice Scale of Edema Status in Critically Ill Patients for ICU nurses by Delphi expert consultation method, the level of knowledge, attitude and practice of edema status of ICU nurses in six tertiary hospitals in Shanghai City was investigated by using convenience sampling method.Results:A total of 292 ICU nurses were investigated by questionnaire. The total scores of knowledge dimension, attitude dimension and practice dimension of critical patients with edema in ICU nurses were 38.27 ± 5.52, 58.33 ± 8.34 and 43.04 ± 8.05, respectively. Multiple stepwise regression analysis showed that age ( β=0.28, P<0.05) was the main factor affecting ICU nurses′ knowledge about edema state of critically ill patients; age( β=0.20, P<0.05) and education ( β=0.28, P<0.05) were the factors affecting ICU nurses' attitude towards edema state of critically ill patients; and years of nursing work ( β=0.28, P<0.05) was the factor affecting the practice of critically ill patients of ICU nurses. Conclusions:The level of knowledge and attitude towards edema in critically ill patients of ICU nurses is good, but the level of behavior is general. Nursing managers should strengthen the training related to edema for ICU nurses, further to form a standardized prevent-treatment plan and nursing process in order to actively improve the nursing practice of edema in critically ill patients.

OBJECTIVE: To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients. METHODS: Ninety obese patients (BMI 30-39.9 kg/m RESULTS: The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T ( CONCLUSIONS Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.
Anesthesia, General ; Humans ; Insufflation ; Intubation, Intratracheal ; Masks ; Obesity

OBJECTIVE：To investigate th e cognition ，attitude and behavior of part of drug practitioners in Shenzhen on compensation of adverse drug reaction （ADR）injury，and to provide relevant reference for the establishment of ADR injury compensation system. METHODS ：Taking marketing authorization holder （MAH），staff of medical institutions at the second level or above and drug regulatory authorities in the relevant meeting held in Shenzhen in 2018 as objects ，on-the-spot anonymous investigation of “questionnaire star ”was used to collect and analyze the cognition ，attitude（including attitude towards ADR compensation and ADR compensation system ）and behavior of the above-mentioned personnel to ADR compensation. The relevant suggestion was put forward. RESULTS & CONCLUSIONS ：A total of 172 questionnaires were collected （all being valid ）. In term of cognition ，the respondents generally had high awareness of ADR （response rate of ADR concept was 82.0％）. In term of attitude to ADR injury compensation ，100 respondents（58.1％）believed that ADR after medication should be compensated ，and 147 respondents（85.5％）believed that compensation should be made for serious and fatal adverse reactions. In term of attitude to ADR injury compensation system ，respondents thought that ADR damage compensation funds be undertaken by MAH for 131 case times （76.2％）. As for the difficulties in the implementation of ADR compensation ，it was considered that the evaluation of the correlation between adverse reactions and drugs led to the difficulties in the implementation of ADR compensation （143 case times ， 83.1％）；most respondents thought that the first thing to do in the implementation of ADR compensation system was to implement laws and regulations （145 case times ，84.3％）. In term of behavior ，104 respondents（60.5％）had processed costs due to ADR ， most of whom chose self-resolved （85 cases，81.7％）；112 respondents （65.1％） chose to inform medical personnels or pharmacies directly. It is suggested that the relevant departments in Shenzhen should explore and establish ADR injury compensation mechanism in Shenzhen by establishing a public oriented platform and mechanism for ADR science popularization （setting up relevant departments ，supervising the public propaganda of news media ，expanding the public propaganda to the commu nity），exploring and establishing ADR injury compensation mechanism （setting up a special legislative pilot of ADR injury regulations ，setting up ADR injury appraisal committee ），and increasing the investment in ADR testing （fully using of “Internet+”Big Data ，allocating special funds ）.