Clinical practice guidelines represent the best recommendations for patient care. They are developed through systematically reviewing currently available clinical evidence and weighing the relative benefits and risks of various interventions. However, clinical practice guidelines have to go through a long translation cycle from development and revision to clinical promotion and application, facing problems such as scattered distribution, high duplication rate, and low actual utilization. At present, the clinical practice guideline information platform can directly or indirectly solve the problems related to the lengthy revision cycles, decentralized dissemination and limited application of clinical practice guidelines. Therefore, this paper systematically examines different types of clinical practice guideline information platforms and investigates their corresponding challenges and emerging trends in platform design, data integration, and practical implementation, with the aim of clarifying the current status of this field and providing valuable reference for future research on clinical practice guideline information platforms.

OBJECTIVES: To explore the mechanism of Shuangshu Decoction (SSD) for inhibiting growth of gastric cancer xenografts in nude mice. METHODS: Network pharmacology analysis was conducted to identify the common targets of SSD and gastric cancer cell ferroptosis, and bioinformatics analysis and molecular docking were used to validate the core targets. In the cell experiment, AGS cells were treated with SSD-medicated serum, Fer-1 (a ferroptosis inhibitor), or both, and the changes in cell viability, ferroptosis markers (ROS, Fe²⁺ and GSH), expressions of P53, SLC7A11 and GPX4, and mitochondrial morphology were examined. In a nude mouse model bearing gastric cancer xenografts, the effects of gavage with SSD, intraperitoneal injection of Fer-1, or their combination on tumor volume/weight, histopathology, and expressions of P53, SLC7A11 and GPX4 levels were evaluated. RESULTS: The active components in SSD (quercetin and wogonin) showed strong binding affinities to P53. In AGS cells, SSD treatment dose-dependently inhibited cell proliferation, increased ROS and Fe²⁺ levels, upregulated P53 expression, and downregulated the expressions of SLC7A11 and GPX4, but these effects were effectively attenuated by Fer-1 treatment. SSD also induced mitochondrial shrinkage and increased the membrane density, which were alleviated by Fer-1. In the tumor-bearing mouse models, gavage with SSD significantly reduced tumor size and weight, caused tumor cell necrosis, upregulated P53 and downregulated SLC7A11 and GPX4 expression in the tumor tissue, and these effects were obviously mitigated by Fer-1 treatment. CONCLUSIONS SSD inhibits gastric cancer growth in nude mice by inducing cell ferroptosis via the P53/SLC7A11/GPX4 axis.
Ferroptosis/drug effects* ; Animals ; Stomach Neoplasms/metabolism* ; Tumor Suppressor Protein p53/metabolism* ; Mice, Nude ; Phospholipid Hydroperoxide Glutathione Peroxidase ; Drugs, Chinese Herbal/pharmacology* ; Humans ; Amino Acid Transport System y+/metabolism* ; Mice ; Cell Line, Tumor ; Cell Proliferation/drug effects* ; Xenograft Model Antitumor Assays

L-citrulline is a nonprotein amino acid that plays an important role in human health and has great market demand. Although microbial cell factories have been widely used for biosynthesis, there are still challenges such as genetic instability and low efficiency in the biosynthesis of L-citrulline. In this study, an efficient, plasmid-free, non-inducible L-citrulline-producing strain of Escherichia coli BL21(DE3) was engineered by combined strategies. Firstly, a chassis strain capable of synthesizing L-citrulline was constructed by block of L-citrulline degradation and removal of feedback inhibition, with the L-citrulline titer of 0.43 g/L. Secondly, a push-pull-restrain strategy was employed to enhance the L-citrulline biosynthesis, which realized the L-citrulline titer of 6.0 g/L. Thirdly, the NADPH synthesis and L-citrulline transport were strengthened to promote the synthesis efficiency, which achieved the L-citrulline titer of 11.6 g/L. Finally, fed-batch fermentation was performed with the engineered strain in a 3 L fermenter, in which the L-citrulline titer reached 44.9 g/L. This study lays the foundation for the industrial production of L-citrulline and provides insights for the modification of other amino acid metabolic networks.
Citrulline/biosynthesis* ; Escherichia coli/genetics* ; Metabolic Engineering/methods* ; Fermentation ; NADP/biosynthesis*

This study aims to promote the system construction of public health talent through understanding the status and identifying problems of public health human resources in Weihai City. A survey on professional public health institutions was conducted through questionnaires and interviews in Weihai City, and statistical analysis on the personnel structure, introduction, and turnover of professional public health institutions was conducted. There were 24 professional public health institutions in Weihai City, with a vacancy rate of 44.27% (1 367/3 088). Health professionals accounted for 68.09% (1 669/2 451) of the on-duty personnel. The number of health technicians in professional public health institutions in the city was 0.57 per thousand people. Among the 1 669 health professionals, the age groups≤35, 36-45, 46-54, and ≥55 accounted for 47.63% (795/1 669), 30.26% (505/1 669), 18.10% (302/1 669), and 4.01% (67/1 669), respectively. The personnel with bachelor′s degrees and master′s degrees accounted for 74.60% (1 245/1 669) and 8.09% (135/1 669). The personnel holding clinical medical, nursing, laboratory, and public health qualifications accounted for 61.34% (995/1 622), 28.30% (459/1 622) and 10.36% (168/1 622), respectively. Only 17.73% (296/1 669) of personnel held deputy senior or above technical titles, while 45.96% (767/1 669) held junior or below technical titles. About 70.10% (1 170/1 669) personnel held permanent positions, and 29.90% (499/1 669) held non-permanent positions. From 2021 to 2023, the employment rate of public health institutions was 65.51% (207/316), and the ratio of introduced and lost personnel was approximately 3∶2 (207/132).

This study aims to promote the system construction of public health talent through understanding the status and identifying problems of public health human resources in Weihai City. A survey on professional public health institutions was conducted through questionnaires and interviews in Weihai City, and statistical analysis on the personnel structure, introduction, and turnover of professional public health institutions was conducted. There were 24 professional public health institutions in Weihai City, with a vacancy rate of 44.27% (1 367/3 088). Health professionals accounted for 68.09% (1 669/2 451) of the on-duty personnel. The number of health technicians in professional public health institutions in the city was 0.57 per thousand people. Among the 1 669 health professionals, the age groups≤35, 36-45, 46-54, and ≥55 accounted for 47.63% (795/1 669), 30.26% (505/1 669), 18.10% (302/1 669), and 4.01% (67/1 669), respectively. The personnel with bachelor′s degrees and master′s degrees accounted for 74.60% (1 245/1 669) and 8.09% (135/1 669). The personnel holding clinical medical, nursing, laboratory, and public health qualifications accounted for 61.34% (995/1 622), 28.30% (459/1 622) and 10.36% (168/1 622), respectively. Only 17.73% (296/1 669) of personnel held deputy senior or above technical titles, while 45.96% (767/1 669) held junior or below technical titles. About 70.10% (1 170/1 669) personnel held permanent positions, and 29.90% (499/1 669) held non-permanent positions. From 2021 to 2023, the employment rate of public health institutions was 65.51% (207/316), and the ratio of introduced and lost personnel was approximately 3∶2 (207/132).

Objective To analyze the risk factors for extrauterine growth retardation(EUGR)in late preterm infants appropriate for gestational age.Methods The clinical data in 1 402 preterm infants appropri-ate for gestational age delivered and hospitalized in this hospital from January 2016 to June 2022 were analyzed retrospectively.They were divided into the EUGR group(n=244)and the non-EUGR group(n=1 158)ac-cording to whether or not the body weight at discharge was below the 10th percentile of the growth curve for the same gestational age at the same period based on the Fenton's preterm growth curve.The clinical data of preterm infants and mothers of the two groups were collected.The risk factors for EUGR occurrence in pre-mature infants were analyzed.Results Among 1 402 preterm infants appropriate for gestational age,EUGR occurred in 244 cases with the EUGR incidence rate of 17.4％.The EUGR incidence rate had no statistical difference among the different fetal ages of premature infants(P＞0.05).The EUGR incidence rate had sta-tistical difference among different birth weights of premature infants(P＜0.05).The logistic regression anal-ysis showed that male(OR=1.694,95％CI:1.144-2.507),low birth weight(OR=0.989,95％CI:0.988-0.991),feeding intolerance(OR=2.719,95％CI:1.234-5.990),short gestational weeks(OR=0.146,95％CI:0.103-0.207)and hospitalization duration extension(OR=1.073,95％CI:1.031-1.117)were the risk factors for EUGR occurrence in late premature infants appropriate for gestational age in discharge.The sub-group analysis showed that male,low birth weight,feeding intolerance and hospitalization duration extension were the risk factors for EUGR occurrence in the preterm infants with gestational ages of 34-＜36 weeks(P＜0.05).Low birth weight and feeding intolerance only affected the preterm infants≥36 weeks of gesta-tional age(P＜0.05).Conclusion Strengthening the pregnant duration health care and active nutritional sup-port after birth may reduce the risk of EUGR occurrence in late premature infants.

Information construction helps hospitals to accurately manage the blood glucose levels of hospitalized patients and improve the quality and safety of medical care. In July 2022, a large tertiary public hospital launched an information management of perioperative patient blood glucose. By establishing a multidisciplinary support and information management team, building an information-based blood glucose management system, establishing standardized management processes, implementing automatic hierarchical blood glucose warning, blood glucose critical value warning and control, abnormal blood glucose consultation, and insulin pump management, the hospital had achieved the information sharing of blood glucose perioperative patients, as well as timely warning and handling of abnormal blood glucose, ensuring patient safety. As of June 2023, the hospital had deployed a total of 364 intelligent blood glucose meters in clinical departments, and monitored blood glucose levels for 12 216 perioperative patients. The blood glucose compliance rate of perioperative patients increased from 81.81% in July 2022 to 82.95% in June 2023. This practice brought convenience to the work of clinical departments, improved the overall quality of medical services in hospitals, and could provide references for other hospitals to carry out blood glucose information management.

Objective To observe the value of 18F-FDG PET/CT semi-quantitative parameters for predicting spread through air spaces(STAS)of clinical stage Ⅰa—Ⅲa lung adenocarcinoma.Methods Data of 85 patients with clinical stage Ⅰa—Ⅲ a lung adenocarcinoma who underwent preoperative 18F-FDG PET/CT were retrospectively analyzed.The patients were divided into positive group(n=23)or negative group(n=62)according to whether pathology showed STAS or not.Clinical and PET/CT data were compared between groups,and logistic analysis was performed to explore the efficacy of each parameter for predicting STAS.Results Significant differences of gender,carcinoma embryonic antigen,clinical stage,pathological grade,micropapillary growth and proportion were found between groups(all P＜0.05).The maximum,the mean,the peak standard uptake value(SUVmax,SUVmean,SUVpeak),as well as the maximum,the mean and the peak standard uptake value normalized by lean body mass(SULmax,SULmean,SULpeak),also the total lesion glycolysis(TLG)in positive group were all significantly higher than those in negative group(all P＜0.05).Patients'gender,proportion of micropapillary growth,SUVmax and SULmax were all independent risk factors of STAS of clinical stage Ⅰa—Ⅲa lung adenocarcinoma.The area under the curve(AUC)of the above parameters for predicting STAS was 0.666,0.912,0.839 and 0.842,respectively,and of the combination was 0.957.Conclusion 18 F-FDG PET/CT semi-quantitative parameters SUVmax and SULmax were helpful for predicting STAS of clinical stage Ⅰa—Ⅲ a lung adenocarcinoma,and further combination of gender and proportion of micropapillary growth could improve diagnostic efficacy.

Objective To explore the research status and future development trends of nursing case teaching at home and abroad,and to provide reference and guidance for the development of case teaching in nursing profession in China.Methods Data sources include the China National Knowledge Infrastructure(CNKI),Wanfang Data,and Web of Science databases.The CiteSpace software was used to visually analyze the research status and trends of nursing case teaching from January 2013 to Octo-ber 2023,covering nearly 11 years.Results A total of 2 889 valid articles were extracted.The important literature on nursing case teaching in China experienced a period of stable growth followed by rapid growth from 2013 to 2021.However,the number of publications and the number of publications in core journals on nursing case teaching abroad were higher than those in China.After 2021,both domestic and foreign publications on nursing case teaching showed a slow decline.The research on nursing case teaching in both domestic and foreign contexts is mainly conducted by universities,and the collaborative relationships between for-eign institutions and scholars are stronger than those within China.The research topics and hotspots in both domestic and foreign contexts are concentrated on the teaching applications for nursing students.Conclusion Nursing case teaching in China contin-ues to attract attention;however,compared to nursing case teaching abroad,the depth and breadth of research need to be further improved.Additionally,the collaboration between domestic authors and institutions is relatively limited.