ObjectiveTo investigate the possible mechanism of Pibai Yucuo Formula （枇柏愈痤方， PYF） in treating acne from the perspective of skin barrier damage. MethodsThirty-two mice were randomly divided into blank group， model group， minocycline group， and PYF group， with 8 mice in each group. Except for the blank group， mice were induced by intradermal injection of Cutibacterium acnes （C.acnes） combined with topical application of artificial sebum to establish acne model. The blank group and model group received intragastric administration of 0.2 ml of distilled water， while the PYF group received intragastric administration of 22.75 g/（kg·d）of PYF， and the minocycline group received 0.013 g/（kg·d）of minocycline suspension， all once daily for 5 consecutive days. On day 0 and day 6 of the experiment， the body weight of mice in each group was recorded， and the absolute value of the body weight difference during the experiment was calculated. Skin conditions were assessed with multifunctional skin imaging system on the 2nd， 4th and 6th day of the experiment. Skin barrier function indicators including transepidermal water loss （TEWL）， and the water content of the stratum corneum and epidermis on day 0， 2， 4 and 6 of the experiment. Optical coherence tomography （OCT） was used to observe stratum corneum and skin thickness on the 1st， 3rd and 5th day of the experiment. Hematoxylin-eosin （HE） staining was performed to observe histopathological changes， while ELISA was used to detect interleukin-17A （IL-17A） levels， and immunofluorescence staining was used to assess skin barrier-related proteins filaggrin （FLG） and loricrin （LOR） levels of skin lesions on day 6 of the experiment. ResultsCompared to the blank group， the model group showed a decrease in body weight on day 6， and an increase in the absolute value of the difference in body weight before and after the experiment （P＜0.05）. On day 4 and 6， TEWL values increased， while water content in the skin stratum corneum and epidermis decreased （P＜0.05）， accompanied by elevated IL-17A level and reduced immunofluorescence intensity of FLG and LOR proteins （P＜0.05）. The model group mice showed papules or pustules at the skin modeling site with progressively worsening desquamation under multifunctional skin imaging system. OCT revealed focal epidermal protrusions， blurred epidermal-dermal boundaries， and disorganized structural layers. HE staining showed significant epidermal hyperkeratosis and incomplete keratinization in the skin， with keratin plug formation in hair follicles and glandular lumens， thickened stratum corneum， hyperplasia of the stratum spinosum， as well as dense dermal inflammatory cell infiltration， and capillary dilation. Compared to the model group， both the minocycline group and the PYF group showed a reduced difference in body weight before and after experiment （P＜0.05）. On day 4 and 6， the TEWL value decreased， and water content of the skin stratum corneum increased （P＜0.05）； on day 6， the IL-17A level in the skin lesions decreased and immunofluorescence intensity of FLG and LOR proteins increased （P＜0.05）. On day 4 and 6， the severity of the skin lesions and range of redness and swelling were lighter than those in the model group， with reverted epidermal thickness， smoother surface and clearer epidermis-dermis boundary. HE staining showed that the degree of skin keratinization was reduced， and the inflammatory infiltration and vascular dilation in the dermis were improved compared to the model group. The PYF group showed better results than the minocycline group in reducing TEWL value on day 4 （P＜0.05）. ConclusionPYF may improve inflammation and skin barrier damage by downregulating IL-17A levels in lesion tissue and increasing skin barrier-related proteins， which could be one of the potential mechanism of action on acne.

ObjectiveTo explore the possible action mechanism of Qingshi Anti-itch Ointment （青石止痒软膏， QAO） in the treatment of psoriasis. MethodsForty mice were randomly divided into four groups， blank group， model group， calcipotriol group and QAO group， with 10 mice in each group. Except for the blank group， psoriasis was induced by applying imiquimod cream to the dorsal skin. After modeling for 6 hours daily， the calcipotriol group and QAO group were treated with 0.5 g of calcipotriol ointment or 0.5 g of QAO， respectively， applied to the treated dorsal skin. The blank group and the model group received no treatment. The skin lesions were observed， and the psoriasis area and severity index （PASI） score was assessed every other day. After 7 days， Hematoxylin and Eosin （HE） staining was performed on dorsal skin tissue to observe pathological changes. The levels of interleukin 1β （IL-1β） and interleukin 18 （IL-18） were determined by enzym-linked immunosorbent assay （ELISA）. The protein levels of Caspase-1，Pro-Caspase-1， gasdermin D （GSDMD） and gasdermin-D-N （GSDMD-N） were detected by Western Blot （WB）. The protein levels of GSDMD were observed by immunohistochemistry. ResultsCompared with the blank group， the model group mice showed redness， erythema， and white scales on their skin， with histological observations indicating epidermal thickening， elongated spines， and infiltration of inflammatory cells. The PASI scores of the skin tissue on days 1， 3， 5， and 7 were elevated； the IOD and AOD values of GSDMD protein increased； the protein levels of Caspase-1， Pro-Caspase-1，GSDMD， GSDMD-N， and IL-1β and IL-18 were significantly elevated （P＜0.05 or P＜0.01）. Compared with the model group， the QAO group and calcipotriol group showed lighter skin lesions； the PASI scores on day 5 and day 7 in the QAO group， and on day 3， 5， and 7 in the calcipotriol group， were reduced； the IOD and AOD values of GSDMD protein， and the protein level of Caspase-1， GSDMD， and GSDMD-N， as well as level of IL-18 and IL-1β decreased in both groups； in the calcipotriol group， Pro-Caspase-1 protein level also decreased （P＜0.05 or P＜0.01）. Compared with the calcipotriol group， the QAO group showed slightly redder skin， more obvious thickening of the stratum corneum， and less capillary dilation； the PASI scores on day 3 and day 7 increased， while the score on day 5 was reduced； the protein level of Pro-Caspase-1， GSDMD， GSDMD-N， and the level of IL-18 and IL-1β were increased in the QAO group （P＜0.05）. ConclusionQAO can effectively relieve psoriasis dermatitis in mice. Its potential mechanism may be related to the regulation of the Caspase-1/GSDMD protein pathway， down-regulation of IL-18 and IL-1β levels， and alleviation of pyroptosis.

ObjectiveTo evaluate the clinical efficacy and safety of Huaban Jiedu Formulation （化斑解毒方， HJF） in treating psoriasis vulgaris with blood-heat syndrome. MethodsA randomized， double-blind， placebo-controlled study was conducted with 60 patients diagnosed with psoriasis vulgaris of blood-heat syndrome. Patients were randomly assigned to either a treatment group or a control group， with 30 cases in each. The treatment group received HJF granules orally， one dose a day， combined with topical Qingshi Zhiyang Ointment （青石止痒软膏）， while the control group received placebo granules， one dose a day， combined with the same topical ointment. Both groups were topically treated twice daily of 28 days treatment cours. Psoriasis area and severity index （PASI）， visual analogue scale for pruritus （VAS）， traditional Chinese medicine （TCM） syndrome scores， dermatology life quality index （DLQI）， and psoriasis life stress inventory （PLSI） were assessed before treatment and on day 14 and day 28. Response rates for PASI 50 （≥50% reduction） and PASI 75 （≥75% reduction）， as well as overall clinical efficacy， were compared between groups. Serum levels of interleukin-6 （IL-6） and interleukin-17 （IL-17） were measured before and after 28 days of treatment. Adverse reactions during treatment were recorded. ResultsAfter 28 days of treatment， both groups showed significant reductions in PASI total score， lesion area score， erythema， scaling， and infiltration scores， pruritus VAS score， TCM syndrome score， DLQI， PLSI， and serum IL-6 and IL-17 levels （P＜0.05）. Compared to the control group， the treatment group had significantly greater improvements in PASI total score and erythema score， TCM syndrome score， serum IL-6 and IL-17 levels， and PASI 50 response rate after 28 days （P＜0.05）. Between-group comparisons of score differences before and after 28-day treatment revealed that the treatment group showed significantly better improvements in PASI total， lesion area score， erythema score， TCM syndrome score， DLQI， PLSI， and inflammatory markers （P＜0.05 or P＜0.01）. The total effective rate on day 14 and day 28 was 40.00% （12/30） and 83.33% （25/30） in the treatment group， versus 6.90% （2/29） and 41.38% （12/29） in the control group， respectively. The clinical efficacy in the treatment group was significantly superior to that in the control group （P＜0.05）. Mild gastric discomfort occurred in 3 patients in the treatment group and 1 in the control group. ConclusionHJF can effectively improve skin lesions and TCM symptoms relieve pruritus， enhance quality of life， and reduce inflammatory markers IL-6 and IL-17， in patients with blood-heat syndrome of psoriasis vulgaris， with a good safety profile.

Objective:To evaluate the early efficacy of local application of tranexamic acid on the osteotomy surface during hallux valgus surgery in reducing postoperative occult blood loss and thus postopera-tive swelling.Methods:The data of 40 cases with hallux valgus osteotomy admitted to the Department of Foot and Ankle Surgery of Jishuitan Hospital from July 11,2022 to October 8,2022,including 5 males and 35 females were retrospectively analyzed.According to the inclusion and exclusion criteria,32 cases were finally divided into 16 cases in the observation group(application of tranexamic acid)and 16 cases in the control group(no application of tranexamic acid).The observation group was paired with the con-trol group one by one in accordance with the operation style,and the change in the anterior and posterior diameter of the first metatarsal head,the change in the circumferential diameter of the foot,the length of the first metatarsal midline and the length of the plumbline of the foot measured by postoperative CT were compared between the two groups before and after surgery,in order to evaluate the degree of swelling around the incision after the surgery.The first metatarsal midline and plumb line were measured by reference to the two auxiliary lines that intersect the soft tissue border in the sesamoid bone position to measure the rotation angle of the first metatarsal.A total of three clinicians completed the measurements of these two line segments and interobserver comparisons were performed.Results:By interobserver com-parison,the consistency of the length of the midline of the first metatarsal and the plumbline measured by CT was high and could be considered a reliable measurement.After the paired t-test,there was no statis-tical difference in the amount of changes in the anteroposterior diameter of the first metatarsal before and after surgery between the observation and control groups(P＞0.05),and the amount of changes in the circumferential diameter of the foot before and after surgery was smaller in the observation group than in the control group,which was statistically significant(P＜0.05);the length of the midline of the first metatarsal and the plumbline of the foot measured by CT after surgery was smaller in the observation group than in the control group,which was statistically significant(P＜0.05).Conclusion:Local ap-plication of tranexamic acid on the osteotomy surface during hallux valgus osteotomy can relieve postopera-tive swelling to some extent,which may be related to the fact that tranexamic acid reduces occult blood loss in the postoperative period.

This paper summarized LI Yuanwen's clinical experience in treating children with atopic dermatitis. It is considered that the core pathogenesis of children's atopic dermatitis is liver constraint and spleen deficiency， for which the main treatment methods are soothing the liver and fortifying the spleen， regulating blood and extinguishing wind， and self-made Jiawei Guomin Decoction （加味过敏煎） can be used. In clinical practice， children with atopic dermatitis are mainly divided into six types including heart fire hyperactivity， blood heat and exuberant toxin， damp pathogen congestion， disharmony of spleen and stomach， blood deficiency and wind-dryness， and yang deficiency and blood stasis. Jiawei Guomin Decoction with modifications in accordance with differentiated syndromes is recommended together with external used Qingshi Zhiyang Ointment （青石止痒软膏）.

Objective:To analyze the common disease spectrum and medication of field medical team in our hospital in summer, and to provide medical and medicinal material supply for field medical team.Methods:The data of all cases of field medical team members during the training period were collected. The types and composition ratio of diseases were analyzed, the drug consumption was counted, and the drug use indicators were calculated including daily drug dose (DDDs), daily drug dose cost (DDDC), drug utilization rate (DUR) and drug ranking ratio (R).Results:During the 12 days of the field training in summer, 77 field medical team members had 91 medical visits and 117 cases of diseases, including 44 males and 33 females, with an average age of 39.7 years. There were 52 cases of respiratory diseases, 21 cases of digestive diseases, 18 cases of mosquito bites and skin diseases, 15 cases of trauma and skeletal muscle system diseases, 5 cases of ophthalmic diseases, 2 cases of neurological diseases, 2 cases of gynecological diseases, 1 case of oral diseases and 1 case of heat stroke. The top five drugs of DDDs and DUR were respiratory drugs, sensory organ drugs, dermatological drugs, antibiotic drugs, digestive system drugs and musculoskeletal system drugs.Conclusions:The disease composition and drug demand of field training in summer have certain characteristics. It is of great guiding significance to know the characteristics of disease incidence and drug consumption of field training for the medical support ability and training tasks for field medical teams in field training in summer.

Objective:To investigate the current status and influencing factors of kinesiophobia in adult burn patients.Methods:A single center cross-sectional research method was conducted. A total of 170 adult burn patients, meeting the inclusion criteria, were admitted to the Department of Plastic Surgery and Burns of the West China Hospital of Sichuan University from October 2018 to December 2019. On admission, the self-made general information questionnaire was used to investigate the gender, age, education level, marital status, payment method of medical expenses, injury factors, and total burn area of patients. One month after admission or before discharge, the presence and degree of kinesiophobia of patients were evaluated by the Tampa Scale for Kinesiophobia (TSK), their pain degrees (results averaged) at the time of burn, debridement and dressing change, after burn operation, and at rest were evaluated by the Visual Analogue Scale, their social support levels were evaluated by the Social Support Revalued Scale, and their degrees of anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale. According to the TSK score, the patients with score >37 points were included into kinesiophobia group, and the patients with score ≤37 points were included into non-kinesiophobia group. The general information of patients in the two groups, as well as the pain score, social support level score, anxiety score, and depression score mentioned above, were recorded. Data of patients between the two groups were statistically analyzed with unifactor analysis including chi-square test, independent sample t test, and Mann-Whitney U test. The factors with statistically significant differences in unifactor analysis were used as variables for multivariate logistic regression analysis to screen out the independent influencing factors of kinesiophobia in adult burn patients. Results:Questionnaires and scales of 170 patients were collected, and the recovery rate was 100%. The data of two patients complicated with cranial fracture aggravation were removed, and 168 valid data were obtained, with the effective rate of 98.82%. Among the 168 patients, 88 were male (52.38%) and 80 were female (47.62%), aged from 18 to 71 (41±6) years. Most of the patients had secondary school education or below, were married, and with no out-of-pocket medical expenses. The main factors of injury were flame and hydrothermal fluid, and the total burn area was 2%-75% ((28±5)%) total body surface area. The TSK score was (41±5) points, the pain score was 4.0 (2.6, 7.0) points, the social support level score was (40±5) points, the anxiety score was 8.5 (7.0, 13.0) points, and the depression score was 9.5 (6.5, 12.0) points. A total of 98 patients had kinesiophobia, and the incidence of kinesiophobia was 58.33%. There were no statistically significant differences in gender, age, educational level, marital status, or injury factors of patients between kinesiophobia group and non-kinesiophobia group ( P>0.05). The percentage of out-of-pocket expenses, total burn area, pain score, anxiety score, and depression score of patients in kinesiophobia group were significantly higher than those in non-kinesiophobia group ( χ2=6.402, t=2.39, Z=-8.05, -6.68, -7.89, P<0.05 or P<0.01), and the social support level score of patients in kinesiophobia group was significantly lower than that in non-kinesiophobia group ( t=5.22, P<0.01). The multivariate logistic regression analysis showed that total burn area, pain score, social support level score, anxiety score, and depression score were the independent influencing factors for the development of kinesiophobia in adult burn patients (odds ratio=0.79, 1.45, 0.78, 1.15, 1.17, 95% confidence interval=0.80-0.92, 1.24-1.74, 0.65-0.91, 1.06-1.29, 1.03-1.24, P<0.01). Conclusions:The incidence of kinesiophobia in adult burn patients is high, and the degree of kinesiophobia is mainly affected by total burn area, pain, social support level, anxiety and depression degrees, and so on. Thus these factors should be taken into consideration when designing interventions to reduce the incidence and degree of kinesiophobia.

Objective:To assess the application effectiveness of problem-based learning (PBL) on nursing teaching in higher vocational schools.Methods:A total of 204 nursing students, including 76 students from Grade 2017 and 128 students from Grade 2018, were selected and divided into the observation group, which included 41 students from Grade 2017 and 74 students from Grade 2018 receiving PBL method, and the control group, which encompassed the others receiving traditional teaching methods. General self-efficacy feelings and problem-solving abilities of students in different grade in two groups were assessed at the beginning and the end of the term.Results:The scores of general self-efficacy feeling between the observation group and the control group at the beginning of the term showed no statistically significant differences ( P>0.05); the scores of general self-efficacy feeling at the end of the term in the observation group were obviously higher than those in the control group [(32.21±4.17) vs. (28.25±3.74), t=7.067, P<0.01]. The scores in Grade 2017 and Grade 2018 in the observation group were (32.61±3.79) and (31.99±4.38), respectively, which were significantly higher than those in the control group in Grade 2017 (27.45±3.95) and in Grade 2018 (28.74±3.55) at the end of the term. The scores of problem-solving abilities in Grade 2017 and Grade 2018 in the observation group were (25.35±2.78) and (25.99±3.19), respectively, which were significantly higher than those in the control group [(21.34±2.92), (21.30±3.51), t=6.064, t=7.679, P<0.01, P<0.01]. Conclusion:PBL method in nursing students can effectively improve the general self-efficacy feeling and problem-solving ability of students, which is worthy of promotion in higher vocational schools.

ObjectiveTo explore the clinical features and factors inlfuencing the prognosis of childhood non-Hodgkin's lymphoma (NHL).MethodsPathologically diagnosed 78 pediatric patients with NHL and treated in the Afifliated Hospital of Qingdao University from January 2004 to August 2013 were collected and analyzed. Patients were grouped according to age, sex, tumor size, immunologic classiifcation, B-symptoms, LDH, hemoglobin and clinical staging. The 5-years event-free survival rate (EFS) were calculated and analyzed by Kaplan-Meier method, and the difference of the survival rate between groups were com-pared. Using Cox proportional hazards model, we analyzed the possible factors that might inlfuence 5-years event-free survival rate EFS , such as age and clinical staging. TheOR value and the 95%CI were calculated.ResultsAmong the 78 cases, median age of onset is 7 years old, male to female ratio is 2.90:1, there are 25 cases of T-cell type and 53 cases of B-cell type. According to pathological types,Burkitt lymphoma is the most common (34.6%), followed by T-lymphoblastic lymphoma (20.5%), diffuse large B-cell lymphoma (11.5%). According to the St. Jude malignant lymphoma staging system, there are 2 cases in stage I, 9 in stageⅡ, 35 in stageⅢ and 32 in stageⅣ. Swelling of periphery lymph node (80.7%) was observed as initial symptom in 26 cases of lymphoblastic lymphoma. Among 45 cases of mature B-cell tumor, the main clinical feature including abdominal cavity and gingival were observed in 27 cases of Burkitt lymphoma. Among the 73 cases received treatments, 66 cases (90.5%) attained CR (complete remission) and 4 cases (5.5%) attained PR (partial remission) by cytology and radiographic assessment after two course of combined chemotherapy, 2 cases (2.7%) rapidly relapsed after the remisson of one course treatment, 1 case (1.3%) appeared the central nervous system inifltration in the chemotherapy. With median follow-up time of 42 months, the 5-year EFS of the 73 cases was (67.0+5.5)%. Single factor analysis showed that B-symptom, LDH, and clinical staging were signiifcantly correlated with prognosis (P<0.05), while age, sex, tumor size, hemoglobin and immune classiifcation was independent of prog-nosis (P>0.05). Multiple factor analysis showed that LDH and clinical staging inlfuenced the prognosis (OR=3.34,95%CI 2.275?10.683,P<0.01;OR=4.354,95%CI 1.519?12.475,P<0.01) .Conclusionclinical features of childhood NHL are variable. LDH and clinical staging at primary diagnosis are important factors affecting the prognosis.

The construction of excellent courses is one important measure of carrying out the teaching quality project in university.To improve the quality of the construction of excellent courses,we must emphasize some basic operation strategies such as practical results,innovation,digital processing and integration.We should adopt workable measures to carry out the teaching quality project in university and strengthen the key position of teaching.