Objective To develop a standardized evaluation index system for assessing teaching quality in clinical teach-ing bases,providing a framework for self-assessment and continuous improvement.Methods An initial set of evaluation indica-tors was developed through a comprehensive literature review.Using the Delphi method,expert opinions were collected via struc-tured questionnaires from 22 specialists in the field.Indicator weights were determined through the fuzzy comprehensive evaluation method.The evaluation frequency and interpretive meaning of each indicator were subsequently established.Results A hierar-chical evaluation index system was constructed,consisting of 3 primary indicators,7 secondary indicators,and 17 tertiary indica-tors.The weight and significance of each indicator were defined.Based on expert consensus,it is recommended that evaluations be conducted once per academic semester.Conclusion The proposed evaluation index system aligns with both clinical and edu-cational principles,features comprehensive and practical content,and is well-suited for self-assessment by clinical teaching ba-ses.It provides a robust reference for enhancing the overall quality of clinical education.

Objective To develop a standardized evaluation index system for assessing teaching quality in clinical teach-ing bases,providing a framework for self-assessment and continuous improvement.Methods An initial set of evaluation indica-tors was developed through a comprehensive literature review.Using the Delphi method,expert opinions were collected via struc-tured questionnaires from 22 specialists in the field.Indicator weights were determined through the fuzzy comprehensive evaluation method.The evaluation frequency and interpretive meaning of each indicator were subsequently established.Results A hierar-chical evaluation index system was constructed,consisting of 3 primary indicators,7 secondary indicators,and 17 tertiary indica-tors.The weight and significance of each indicator were defined.Based on expert consensus,it is recommended that evaluations be conducted once per academic semester.Conclusion The proposed evaluation index system aligns with both clinical and edu-cational principles,features comprehensive and practical content,and is well-suited for self-assessment by clinical teaching ba-ses.It provides a robust reference for enhancing the overall quality of clinical education.

Objective To mine and analyze signals of acute kidney injury(AKI)related to drugs,comprehensively summarize the potential risk drugs,and provide a reference for clinically safe medication.Methods The AKI reports from January 2004 to September 2023 in the US FDA Adverse Event Reporting System(FAERS)were retrieved.Disproportionality methods were used to explore the relationship between drugs and AKI,and demographic information,time to onset,and patient outcomes were analyzed.Results Out of 1 253 drugs,159 were identified as AKI signal drugs.Among these,there were 49 antimicrobial agents(30.82%),including 35 antibiotics and 14 antiviral agents;33 antineoplastic agents(20.75%);and 25 hypotensive agents(15.72%).Drug-related AKI occurred mostly in the elderly,and the male-to-female ratio was 124∶100.The median time to onset for AKI related to antibiotics was≤8 d,with the third quartile≤21 d.Rivaroxaban and aspirin had higher proportions of death reports,with 33.03%and 31.44%respectively.Conclusions A multitude of drugs pose a risk for acute kidney injury,necessitating caution in their clinical application and the implementation of monitoring of renal function.The elderly are a high-risk group for drug-related AKI,and there are more males than females.For antibiotics,the first 21 days are the key monitoring period.For drugs that require long-term use,regular monitoring is necessary.

Objective:To investigate the effect of taxifolin on cartilage damage in osteoarthritis(OA)rats by regulating Sonic hedgehog(Shh)/Gli family zinc finger protein 1(Gli1)signaling pathway.Methods:Rats were randomly separated into control group,OA group,taxifolin group,Shh activator(purmorphamine)group and taxifolin+purmorphamine group,with 12 rats in each group.Except for control group,rats in all other groups were used to construct OA models by the improved Hulth method.After successful modeling,medication treatment began once a day for 4 weeks.Changes in knee joint swelling and maximum range of motion in rats were detected.Saffranine O-solid green staining was applied to detect pathological changes in knee joint cartilage tissue and to perform the Osteoarthritis Research Society International(OARSI)score.ELISA was applied to detect levels of IL-1β,TNF-α and IL-10 in tissue.Immunohistochemical staining was applied to detect expressions of ADAMTS-5 and MMP-13 in knee joint cartilage tissue.Western blot was applied to detect expressions of Shh and Gli1 proteins in knee joint cartilage tissue.Results:Compared with control group,cartilage surface of rats in OA group was damaged,cartilage erosion occurred,and cells were greatly reduced,knee joint swelling,OARSI score,levels of IL-1β and TNF-α in knee cartilage tissue,percentages of ADAMTS-5 and MMP-13 positive cells,Shh and Gli1 protein expressions were elevated,the maximum range of motion and level of IL-10 in knee cartilage tissue were decreased(P<0.05).Compared with OA group,damage to cartilage surface,cartilage erosion and cell reduction were alleviated in taxifolin group,knee joint swelling,OARSI score,levels of IL-1β and TNF-α in knee cartilage tissue,percentages of ADAMTS-5 and MMP-13 positive cells,Shh and Gli1 protein expressions were decreased,while the maximum range of motion and level of IL-10 in knee cartilage tissue were increased,the trend of changes in corresponding indicators in purmorphamine group was opposite to that in taxifolin group(P<0.05).Compared with taxifolin group,pathological damage to knee joint cartilage tissue in taxifolin+purmorphamine group was intensified,knee joint swelling,OARSI score,levels of IL-1β and TNF-α in knee cartilage tissue,percentages of ADAMTS-5 and MMP-13 positive cells,Shh and Gli1 protein expressions were increased,the maximum range of motion and level of IL-10 in knee carti-lage tissue were decreased(P<0.05).Conclusion:The improvement mechanism of taxifolin on cartilage damage in OA rats may be related to the inhibition of the Shh/Gli1 signaling pathway.

Objective To mine and analyze signals of acute kidney injury(AKI)related to drugs,comprehensively summarize the potential risk drugs,and provide a reference for clinically safe medication.Methods The AKI reports from January 2004 to September 2023 in the US FDA Adverse Event Reporting System(FAERS)were retrieved.Disproportionality methods were used to explore the relationship between drugs and AKI,and demographic information,time to onset,and patient outcomes were analyzed.Results Out of 1 253 drugs,159 were identified as AKI signal drugs.Among these,there were 49 antimicrobial agents(30.82%),including 35 antibiotics and 14 antiviral agents;33 antineoplastic agents(20.75%);and 25 hypotensive agents(15.72%).Drug-related AKI occurred mostly in the elderly,and the male-to-female ratio was 124∶100.The median time to onset for AKI related to antibiotics was≤8 d,with the third quartile≤21 d.Rivaroxaban and aspirin had higher proportions of death reports,with 33.03%and 31.44%respectively.Conclusions A multitude of drugs pose a risk for acute kidney injury,necessitating caution in their clinical application and the implementation of monitoring of renal function.The elderly are a high-risk group for drug-related AKI,and there are more males than females.For antibiotics,the first 21 days are the key monitoring period.For drugs that require long-term use,regular monitoring is necessary.

Objective:To investigate the effect of taxifolin on cartilage damage in osteoarthritis(OA)rats by regulating Sonic hedgehog(Shh)/Gli family zinc finger protein 1(Gli1)signaling pathway.Methods:Rats were randomly separated into control group,OA group,taxifolin group,Shh activator(purmorphamine)group and taxifolin+purmorphamine group,with 12 rats in each group.Except for control group,rats in all other groups were used to construct OA models by the improved Hulth method.After successful modeling,medication treatment began once a day for 4 weeks.Changes in knee joint swelling and maximum range of motion in rats were detected.Saffranine O-solid green staining was applied to detect pathological changes in knee joint cartilage tissue and to perform the Osteoarthritis Research Society International(OARSI)score.ELISA was applied to detect levels of IL-1β,TNF-α and IL-10 in tissue.Immunohistochemical staining was applied to detect expressions of ADAMTS-5 and MMP-13 in knee joint cartilage tissue.Western blot was applied to detect expressions of Shh and Gli1 proteins in knee joint cartilage tissue.Results:Compared with control group,cartilage surface of rats in OA group was damaged,cartilage erosion occurred,and cells were greatly reduced,knee joint swelling,OARSI score,levels of IL-1β and TNF-α in knee cartilage tissue,percentages of ADAMTS-5 and MMP-13 positive cells,Shh and Gli1 protein expressions were elevated,the maximum range of motion and level of IL-10 in knee cartilage tissue were decreased(P<0.05).Compared with OA group,damage to cartilage surface,cartilage erosion and cell reduction were alleviated in taxifolin group,knee joint swelling,OARSI score,levels of IL-1β and TNF-α in knee cartilage tissue,percentages of ADAMTS-5 and MMP-13 positive cells,Shh and Gli1 protein expressions were decreased,while the maximum range of motion and level of IL-10 in knee cartilage tissue were increased,the trend of changes in corresponding indicators in purmorphamine group was opposite to that in taxifolin group(P<0.05).Compared with taxifolin group,pathological damage to knee joint cartilage tissue in taxifolin+purmorphamine group was intensified,knee joint swelling,OARSI score,levels of IL-1β and TNF-α in knee cartilage tissue,percentages of ADAMTS-5 and MMP-13 positive cells,Shh and Gli1 protein expressions were increased,the maximum range of motion and level of IL-10 in knee carti-lage tissue were decreased(P<0.05).Conclusion:The improvement mechanism of taxifolin on cartilage damage in OA rats may be related to the inhibition of the Shh/Gli1 signaling pathway.

Objective:To investigate the effects of dexmedetomidine(DEX)on T cell subsets in rats with rheumatoid arthritis(RA)by regulating interleukin-10(IL-10)/signal transduction factor and transcriptional activator 3(STAT3)signaling pathways.Methods:SD rats were grouped into control group(NC group),Model group,DEX low-dose group(DEX-L group,5 μg/kg),DEX medium-dose group(DEX-M group,10 μg/kg),DEX high-dose group(DEX-H group,20 μg/kg),methotrexate group(MTX group,0.33 mg/kg),AS101 group(IL-10 inhibitor,1.5 mg/kg)and DEX-H+AS101 group(20 μg/kg+1.5 mg/kg),with 18 rats in each group.Except NC group,RA models were established in rats of other groups.The administration was started 24 hours after the second immunization,once a day for 3 weeks.The changes of foot swelling rate and joint index were measured;HE staining was applied to detect the pathological changes of spleen tissue;the levels of TNF-α and IL-1β in rat spleen were detected by ELISA;the percentages of CD3+CD4+T cells,CD3+CD8+T cells and the proportions of helper T cell 17(Th17)and regulatory T cell(Treg)in rat spleen were measured by flow cytometry;and Western blot was applied to detect the expressions of IL-10 and p-STAT3 protein in rat spleen.Results:Compared with NC group,the pathological damage of spleen tissue in Model group was serious,the feet swelling rate,joint index,the levels of TNF-α and IL-1β,the percentage of CD3+CD4+T cells,Th17 cells,Th17/Treg were increased,the percentage of CD3+CD8+T cells,Treg,and expression of IL-10 and p-STAT3 protein were decreased(P<0.05);compared with Model group,the pathological damage of spleen tissue in DEX-L group,DEX-M group,DEX-H group and MTX group were reduced,the feet swelling rate,joint index,the levels of TNF-α and IL-1β,the percentage of CD3+CD4+T cells,Th17 cells,Th17/Treg decreased,the percent-age of CD3+CD8+T cells,Treg,and expressions of IL-10 and p-STAT3 protein were increased(P<0.05);compared with Model group,the pathological damage of spleen tissue in AS101 group was aggravated,the feet swelling rate,joint index,the levels of TNF-α and IL-1β,the percentage of CD3+CD4+Tcells,Th17 cells,Th17/Treg were increased,the percentage of CD3+CD8+T cells,Treg cells,and expression of IL-10 and p-STAT3 protein were decreased(P<0.05);AS101 attenuated the promoting effect of high dose DEX on the proportion balance of T cell subsets in RA rats.Conclusion:DEX may promote the balance of T cell subsets in RA rats by activating IL-10/STAT3 pathway.

A retrospective analysis was conducted on data from five patients comprehensively diagnosed with emphysematous osteomyelitis (EO) based on clinical, imaging, microbiological culture, and surgical findings at Hebei Medical University Third Hospital from December 2020 to May 2024. Among these five cases, there were three males and two females, aged between 11 and 69 years. Three patients had infection risk factors (two with diabetes and one with anemia), while two had no documented risk factors in their medical history. All patients presented with fever, localized pain at the infection site, and elevated inflammatory markers. Site of incidence: EO affected the lumbar spine in three cases, the ilium in one case, and the femur in one case. Pathogenic microorganisms: The causative agents included Klebsiella pneumoniae (two cases), Escherichia coli (one case), Burkholderia cepacia (one case), and a mixed infection of Staphylococcus aureus and Acinetobacter baumannii (one case). Imaging findings: Among the three patients who underwent X-ray examinations, one showed normal results, while two exhibited bone destruction. CT scans of all five cases revealed the characteristic "pumice sign" without periosteal reaction or osteosclerosis. MRI, performed on four patients, demonstrated bone destruction, swelling of surrounding soft tissues, and soft tissue abscess formation. Treatment and outcomes: Four patients underwent surgical debridement combined with perioperative antibiotic therapy. Of these, three recovered well, while one achieved good infection control but suffered severe joint destruction. One patient died after treatment was discontinued. The clinical and laboratory findings of EO resemble those of common acute osteomyelitis; however, EO has distinct imaging characteristics. Timely diagnosis, aggressive surgical debridement, and strong, targeted antibiotic therapy can result in favorable outcomes. Conversely, delayed diagnosis and treatment may lead to severe complications or death.

Currently, approximately 2/3 of aspiration cases in stroke patients are silent aspiration. However, due to its occult external symptoms, silent aspiration is difficult to detect, resulting in a much higher risk of developing pneumonia in the later stage compared with overt aspiration. Understanding the pathogenesis of silent aspiration is a prerequisite for taking effective measures, and efficient screening tools are helpful for clinical identification. This article reviews the pathogenesis, assessment tools, and clinical application status of silent aspiration in stroke patients at home and abroad, compares the advantages and disadvantages of the tools, existing problems, and conducts cause analysis, aiming to provide a reference for the application, development, and clinical practice of assessment tools for silent aspiration in stroke patients, and to prevent the occurrence of silent aspiration in stroke patients.

Currently, approximately 2/3 of aspiration cases in stroke patients are silent aspiration. However, due to its occult external symptoms, silent aspiration is difficult to detect, resulting in a much higher risk of developing pneumonia in the later stage compared with overt aspiration. Understanding the pathogenesis of silent aspiration is a prerequisite for taking effective measures, and efficient screening tools are helpful for clinical identification. This article reviews the pathogenesis, assessment tools, and clinical application status of silent aspiration in stroke patients at home and abroad, compares the advantages and disadvantages of the tools, existing problems, and conducts cause analysis, aiming to provide a reference for the application, development, and clinical practice of assessment tools for silent aspiration in stroke patients, and to prevent the occurrence of silent aspiration in stroke patients.