Objective:To explore applications of adjusting timing of nebulization and analgesic usage in patients after lung cancer surgery, to provide reference for postoperative rehabilitation of lung cancer.Methods:Adopting a prospective randomized controlled study design, a total of 84 patients with lung cancer who underwent surgery in affiliated hospital of Jining Medical University from September 2020 to June 2023 were enrolled by a convenience sampling method, they were randomly divided into experimental group and control group according to random number table method. Two groups was given routine perioperative care, on this basis, the control group received lip and abdomen contraction breathing training according to the conventional process, and the experimental group adjusted timing of nebulization and analgesic usage and received respiratory function training when nebulization and analgesics were at the peak of blood drug concentration. Pain level and exercise self-efficacy of two groups were compared.Results:There were 27 males and 15 females in the control group, aged (54.52 ± 14.06) years; and 24 males and 18 females in the experimental group, aged (53.33 ± 12.02) years. At one day, two days and three days after operation, the scores of Numerical Rating Scale (NRS) were (5.07 ± 0.84), (3.40 ± 0.49), (2.93 ± 0.87) in the experimental group, lower than (5.86 ± 1.05), (4.09 ± 0.88), (3.33 ± 0.65) in the control group, the differences were statistically significant ( t=3.79, 4.44.2.42, all P<0.05), and for both groups, the differences in the time effect, between-group effect, and the interaction effect were all statistically significant ( F=582.92, 44.65, 3.82, all P<0.05). Three days after operation, the dimensions of efficacy expectation, outcome expectation and total self-efficacy scores were (28.62 ± 6.75), (33.71 ± 7.04) and (62.33 ± 9.07) in the experimental group, and (25.52 ± 6.66), (30.43 ± 6.80) and (55.95 ± 9.34) in the control group, the differences were statically significant ( t=2.12, 2.18, 3.18, all P<0.05). Conclusions:Adjusting timing of nebulization and analgesic usage and giving respiratory function training for lung cancer surgery when nebulization and analgesics at the peak of blood drug concentration can effectively alleviate the pain caused by respiratory exercise and improve training self-efficacy of patients after lung cancer surgery.

Objective:To analyze the effects of fluorine exposure on calcium ion metabolism and the expression of related calcium-regulating proteins in the kidneys of rats.Methods:Forty-five 5-week-old specific pathogen-free male Wistar rats (weighed 90 - 120 g) were selected and divided into three groups according to the randomized numeric table: 0 (control), 50, and 100 mg/L fluorine exposure groups, with 15 rats in each group. The control group was given deionized water, while the 50 and 100 mg/L fluorine exposure groups were given sodium fluoride solutions containing 50 and 100 mg/L fluorine ions, respectively. After 12 weeks, urine samples were collected, and kidneys and blood were harvested. Urinary fluorine levels were measured using a fluoride ion-selective electrode method. Calcium ion levels in the urine, kidneys, and serum were determinated using the methylthymol blue microplate method. The protein expression levels of transient receptor potential vanilloid receptor 5 (TRPV5), calbindin-D28K (CB-D28K), sodium-calcium exchanger-1 (NCX1), Klotho and plasma membrane calcium ATPase 1b (PMCA1b) in the kidneys were detected by Western blotting and immunohistochemistry.Results:The urinary fluorine levels in the control group and the 50 and 100 mg/L fluorine exposure groups were (0.48 ± 0.09), (20.01 ± 1.68), (37.45 ± 2.45) mg/L, respectively, with statistically significant differences between the groups ( F = 929.58, P < 0.001). Significant differences in calcium ion levels in urine, kidneys, and serum were observed among the three groups ( F = 14.66, 11.09, 10.31, P < 0.05). Compared with the control group, the 100 mg/L fluorine exposure group exhibited higher levels of calcium ion in the urine and kidneys, and lower serum calcium ion levels ( P < 0.05). The results of Western blotting analysis revealed that the protein expression levels of TRPV5 and CB-D28K in the kidneys increased with the increase of fluorine exposure level ( Z = 2.11, 2.11, P = 0.035). The protein expression level of NCX1 in the kidneys showed a decreasing trend with increasing fluorine exposure level ( Z = - 2.11, P = 0.035). Significant differences were also observed in the protein expression levels of Klotho and PMCA1b among the three groups ( F = 8.93, 7.08, P < 0.05). Compared with the control group, the 100 mg/L fluorine exposure group showed higher level of Klotho protein expression and lower level of PMCA1b protein expression in the kidneys ( P < 0.05). Immunohistochemical results indicated significant differences in the protein expression levels of TRPV5, CB-D28K, NCX1, and Klotho in the kidneys of the three groups ( F = 27.56, 24.94, 16.05, 32.72, P < 0.05). Compared with the control group, the protein expression levels of TRPV5, CB-D28K, and Klotho in kidneys of 50 and 100 mg/L fluorine exposure groups were higher, while the protein expression levels of NCX1 were lower ( P < 0.05). Conclusion:Fluorine exposure may cause calcium ion metabolism disorders by regulating the expression levels of Klotho and other calcium-regulating proteins in the kidneys.

Objective:To investigate the effects of combined stent and catheter thrombectomy technique on severe cerebral venous sinus thrombosis.Methods:A single-center, prospective, randomized controlled study was conducted involving 78 patients with severe cerebral venous sinus thrombosis who were treated at Lishui People's Hospital from January 2019 to December 2023. Using the random number table method, these patients were divided into two groups: an experimental group ( n = 39) and a control group ( n = 39). The control group received heparin anticoagulation treatment, while the experimental group underwent stent placement combined with catheter thrombectomy. The patency rate of occluded venous sinuses, Glasgow Coma Scale scores, Glasgow Outcome Scale scores, overall prognosis, and the incidence of adverse events were compared between the two groups. Results:After treatment and at 90 days post-treatment, the patency rate of occluded venous sinuses in the experimental group was 89.7% (35/39) and 79.5% (31/39), respectively. These were significantly higher than those in the control group [71.8% (28/39), 56.4% (22/39), χ2 = 4.04, 4.77, both P < 0.05]. Both the Glasgow Coma Scale scores and Glasgow Outcome Scale scores significantly increased in both groups after treatment, with the experimental group showing higher scores than the control group (all P < 0.05). At 30 and 90 days after treatment, the proportion of patients with a modified Rankin Scale score of ≤ 2 in the experimental group was 87.2% (34/39) and 79.5% (31/39), respectively. These were significantly higher than those in the control group [66.7% (26/39), 53.8% (21/39), χ2 = 4.62, 5.77, both P < 0.05]. There was no significant difference in the total incidence of adverse events between the two groups ( P > 0.05). Conclusions:The stent combined with catheter thrombectomy technique exhibits a considerable application value for patients with severe cerebral venous sinus thrombosis. This approach can enhance the vascular recanalization rate, promote disease recovery, improve patient prognosis, and is considered safe.

BACKGROUND:Skeletal muscle insulin resistance is the key pathological link of type 2 diabetes.The traditional Chinese medicine compound Roujishuncuiyin can effectively improve skeletal muscle insulin resistance,but its mechanism has not been clarified.OBJECTIVE:To explore the mechanism of Roujishuncuiyin on skeletal muscle insulin resistance in type 2 diabetes mice.METHODS:Forty db/db mice with type 2 diabetes mellitus were randomized into a model group,a low-dose Roujishuncuiyin group,a high-dose Roujishuncuiyin group,and a positive drug group,with 10 mice in each group.The latter three administration groups were given 157.5 mg/g and 630 mg/g Roujishuncuiyin and 200 mg/g metformin hydrochloride aqueous solution by gavage once a day,respectively.In addition,10 db/dm mice were selected as the blank control group.Mice in the model and blank control groups were given the same dose of 0.9％NaCl solution by gavage.After 12 weeks of intervention,fasting blood glucose was measured in each group of mice,and oral glucose tolerance test was performed to calculate the area under the blood glucose curve.ELISA was used to detect serum insulin level and calculate the resistance index.Mitochondrial structure of skeletal muscle tissue was observed under transmission electron microscopy.Western blot was used to detect the expression levels and phosphorylation levels of protein kinase B(AKT)and glycogen synthase kinase 3β(GSK-3β)proteins in skeletal muscle.RESULTS AND CONCLUSION:(1)Compared with the blank control group,fasting blood glucose,fasting insulin and insulin resistance index were significantly higher in the model group(P＜0.05),the area under the curve of the oral glucose tolerance test was significantly increased(P＜0.05),the expression of p-AKT and p-GSK3β proteins in tibialis anterior muscle was significantly decreased(P＜0.05),and there was a large amount of mitochondrial damage in tibialis anterior muscle and a large number of lipid droplets in the interstitium.(2)Compared with the model group,fasting blood glucose,fasting insulin,and insulin resistance index were significantly reduced in the low-and high-dose Roujishuncuiyin groups and the positive control group(P＜0.05),the area under the curve of the oral glucose tolerance test was reduced(P＜0.05),the expression of p-AKT and p-GSK3β proteins in the tibialis anterior muscle was significantly elevated(P＜0.05),and mitochondrial damage in the tibialis anterior muscle was significantly ameliorated,with decreased lipid droplets in the interstitium.(3)The above indexes were better in the high-dose Roujishuncuiyin group than the low-dose Roujishuncuiyin group(P＜0.05),while there was no significant difference between the high-dose Roujishuncuiyin group and positive control group(P＞0.05).To conclude,by upregulating the protein levels of p-AKT and p-GSK3β in skeletal muscle tissue,the traditional Chinese medicine compound Roujishuncuiyin can improve structural disorders and mitochondrial morphology in skeletal muscle tissue,reduce insulin resistance in the skeletal muscle and regulate glucose homeostasis in the body.

OBJECTIVE To study the characteristics,micro-traits and microscopic characteristics of Peucedani radix and seven kinds of its common varieties and summarize the key identification characteristics so as to provide a reference for the effective identifica-tion of Peucedani radix and its common varieties.METHODS The key identification features and high-definition images of Peucedani radix and its common varieties were obtained by using the identification methods of traits,microtraits and microscopy,combined with the techniques of depth-of-field extended imaging and image stitching,and some of the features were digitally extracted and statistical-ly analyzed by SPSS26.0 software.RESULTS The high-definition color image data of Peucedani radix and its common varieties were obtained.Its specific identification features were:root head length and annular sparseness,skin pore shape and area,root texture,and fracture surface oil spot density,etc.under the property identification;the diameter and number of oil chambers,the number of cathe-ters,the presence or absence of bast fibers and wood fibers,etc.under the microscopic identification.The results of statistical analysis showed that there were significant differences in skin pore area,oil chamber diameter and density,and conduit density among different varieties of Peucedani radix(P<0.01).CONCLUSION Micro-traits and microidentification methods can be comprehensively ap-plied to distinguish Peucedani radix and its common varieties.In particular,the microscopic features of polarized light holographic col-or images in cross section have significant distinguishing significance,and some of the features are digitally extracted and statistically analyzed,which makes up for the shortcomings of subjective factors in the traditional empirical identification research,and provides a reference for the circulation,testing,clinical medication,and standard drafting of Peucedani radix.

[Objective]To explore the potential therapeutic targets of traditional Chinese medicine(TCM)in the treatment of lung cancer,based on the differences in gut microbiota,for providing new ideas for the TCM diagnosis and treatment of lung cancer.[Methods]Beginning with the TCM theories"Interior-exterior relationship between the lung and the large intestine"and"Simultaneous treatment of lung and intestine",integrating clinical research and empirical evidence,this study aims to clarify the feasibility of treating lung cancer by targeting gut microbiota and to summarize key gut microbiota targets in TCM for lung cancer treatment.[Results]Ancient Chinese medical literature and modern medical research provide a reliable theoretical basis for treating lung cancer based on intestinal microbiota.Empirical clinical prescriptions can regulate the composition and metabolism of gut microbiota.Some of the Chinese medicines in these prescriptions can specifically increase the abundance of key bacteria such as Lactobacillus,Faecalibacterium,and Bifidobacterium,thereby playing a positive role in the treatment of lung cancer.[Conclusion]There is a potential correlation between key gut microbiota in lung cancer patients and Chinese medicine,and regulating gut microbiota may be a target for TCM treatment of lung cancer.In depth exploration of the specific correlation between Chinese medicine and key bacteria,targeting the regulation of gut microbiota to formulate prescriptions,may become a new approach for TCM treatment of lung cancer.

OBJECTIVE To understand the clinical distribution of carbapenem-resistant gram-negative bacteria(CR-GNB)hospital-acquired infections and observe the effectiveness of antimicrobial stewardship(AMS)so as to pro-vide theoretical basis for targeted supervision.METHODS The patients who were detected with CR-GNB in the First People's Hospital of Lianyungang from Jan.1,2015 to Dec.31,2023 were monitored by hospital-ac-quired infection informatization monitoring system,the demographic and etiological data were collected from the patients with hospital-acquired infections,the clinical characteristics were analyzed.The incidence of CR-GNB in-fections,isolation rates and drug administration indexes were observed and compared,and the effectiveness of AMS was evaluated.RESULTS A total of 972 633 hospitalized patients were monitored,1319 of whom had hospi-tal-associated CR-GNB infections,and the total incidence of infections was 0.17％,showing a continuously down-ward trend during the years(P＜0.001).Carbapenem-resistant Acinetobacter baumannii(43.37％),carbapenem-resistant Pseudomonas aeruginosa(29.72％)and carbapenem-resistant Klebsiella pneumoniae(24.94％)ranked the top 3 species of pathogens.The CR-GNB infections were most prevalent in intensive care unit(ICU),followed by geriatrics department and neurosurgery department.Lower respiratory tract was the predominant infection site.The patients of male,no less than 65 years of age,and ICU stay were at higher risk of CR-GNB infections than other populations(P＜0.001).The implementation of AMS reduced the incidence of CR-GNB infections,iso-lation rates,utilization rates of antibiotics,antibiotics prophylaxis rates for type Ⅰ incision surgery and antibiotics use density(P＜0.05).CONCLUSIONS The hospital-associated CR-GNB infection show"U"type epidemiological characteristics.It is necessary to focus on the population characterized by male/the elderly/ICU stay.The imple-mentation of AMS may effectively facilitate the control and detection rate of the CR-GNB infections.

OBJECTIVE To explore the etiological characteristics of diabetic foot infections(DFI),analyze the drug resistance and observe the curative effects so as to provide theoretical bases for targeted diagnosis,treatment,prevention and control of the infections.METHODS A total of 182 patients with DFI who were treated in the Third People's Hospital from Jan.2019 to Dec.2023 were recruited as the research subjects.The indexes were observed and compared among the patients with different Wagner grades of DFI.RESULTS Totally 182 patients were en-rolled in the study,84 of whom were as Wagner grade 2,62 were as grade 3,25 were as grade 4,and 11 were as grade 5.The levels of fasting blood glucose and glycosylated hemoglobin elevated with the increase of the grade,while the albumin level reduced.Pseudomonas aeruginosa(18.35％),Staphylococcus aureus(17.89％)and Esch-erichia coli(15.60％)were the major strains of pathogens;the proportions of gram-negative bacteria increased with the rise of the grade(P＜0.05).The drug resistance of the main gram-negative bacteria to ampicillin,sulfa-methoxazole-trimethoprim and piperacillin were more than 70％;the drug resistance of the main gram-positive bacteria to penicillin and oxacillin were more than 60％.In terms of the risk factors,the proportions of the DFI pa-tients with hyperglycemia,neuropathy and retinopathy declined with the rise of the grade,while the proportions of the DFI patients with long-term use of antibiotics(more than 3 months),more than 2 times of hospitalization each year for the same lesion site,ulcer area no less than 4 cm2 and treatment course of ulcer more than 60 days increased with the rise of the grade(all P＜0.05).In addition,the effective rate of treatment and the eradica-tion rate of pathogens showed downward trends with the rise of Wagner grade(P＜0.05).CONCLUSIONS The DFI is mainly caused by the gram-negative bacilli,the drug resistance rates are generally high.Wagner DF grade is associated with the distribution of pathogens and the antimicrobial effect,based on which the targeted prevention and treatment can be carried out in early stage.

Objective:To analyze the differences in determination of fluoride level in drinking water by ion-selective electrode method and high-throughput rapid determination method.Methods:The precision test was carried out by using the two methods to measure two kinds of fluoride standard substances, water samples of external quality control assessment from 2021 to 2023 (two kinds each year) and the fluoride level in three drinking water samples (for 5 times/each sample). Accuracy testing was conducted by measuring the external quality control assessment water samples and the spiked recovery rates drinking water, and water samples were grouped (water fluoride ≤1.00, > 1.00 mg/L) and analyzed according to the "Hygienic Standards for Drinking Water" (GB 5749-85). SPSS 23.0 software was used for statistical analysis of the measurement results.Results:(1) The correlation coefficients ( r) of the working curves of the two methods were both > 0.990, meeting the quality control requirements. (2) In the precision test, when comparing the results of the two methods for detecting two kinds of fluoride standard substances, there was no statistically significant difference ( F = 0.36, 0.15, P = 0.564, 0.707), and the coefficients of variation ( CV) were all < 5%. The CV of the detection results of the external quality control assessment water samples and drinking water samples were < 5%. (3) In the accuracy test, when the fluoride concentration in water was ≤1.00 mg/L, there was no statistically significant difference in the spiked recovery rates between the two methods ( F = 0.49, P = 0.504). When the fluoride concentration in water was > 1.00 mg/L, there was a statistically significant difference in the spiked recovery rates between the two methods ( F = 24.75, P = 0.003). Conclusions:The ion-selective electrode method has the advantages of wide detection range and wide adaptability, while the high-throughput rapid determination method has high accuracy. Testing personnel can weigh and choose the appropriate determination method based on the actual laboratory conditions and sample concentration range.

Objective:To adapt the Mindful Breastfeeding Scale (MINDF-BFS) into Chinese and assess its reliability and validity among breastfeeding mothers in China.Methods:Following the Beaton cross-cultural adaptation guideline, the original scale was translated, back-translated, discussed by experts, pre-tested, culturally adapted, and revised to develop the Chinese version of the MINDF-BFS. A convenience sampling method was used to select 305 postpartum women from Guangzhou Women and Children's Medical Center, Guangzhou Medical University, who visited between March and June 2024, as the study participants. The reliability and validity of the Chinese version of MINDF-BFS were evaluated.Results:The Chinese version of MINDF-BFS consisted of nine items, with the item-level content validity index ranged from 0.900 to 1.000, and the average scale-level content validity index was 0.990. Exploratory factor analysis extracted one common factor, with a variance contribution of 73.290%. Confirmatory factor analysis showed a good model fit. The Cronbach's α coefficient for the scale was 0.923, the split-half reliability coefficient was 0.915, and the test-retest reliability coefficient was 0.926.Conclusions:The Chinese version of MINDF-BFS has good psychometric properties and is suitable for assessing the mindful breastfeeding levels of Chinese postpartum women.