OBJECTIVE To analyze the risk factors associated with serum digoxin concentration （SDC） exceeding the warning threshold and to construct a risk prediction model. METHODS Clinical data were retrospectively collected from hospitalized patients who received regular oral digoxin and completed therapeutic drug monitoring at Guangzhou First People’s Hospital and Nansha Branch of Guangzhou First People’s Hospital between September 2020 and March 2025. Patients with SDC＞2.0 ng/mL were classified as exceeding the warning threshold group， while those with SDC≤2.0 ng/mL were classified as the non-exceeding the warning threshold group. Based on univariate factor analysis， multivariate Logistic regression analysis was used to identify independent risk factors for SDC exceeding the warning threshold. A prediction model was developed and a nomogram was plotted accordingly. The discriminative ability of the model was evaluated by receiver operating characteristic （ROC） curve analysis， and the calibration curve were plotted to assess the calibration of the model. The Hosmer-Lemeshow test was employed to evaluate the goodness of fit of the model， and clinical utility was evaluated by decision curve analysis （DCA）. RESULTS A total of 254 patients were included， among whom 49 patients （19.29%） had SDC exceeding the warning threshold. Univariate factor analysis and multivariate Logistic regression analysis showed that increased daily dose per kilogram of body weight， advanced age， concomitant coronary heart disease， elevated serum creatinine levels， concomitant use of amiodarone， and concomitant use of deslanoside wer e independent risk factors for SDC exceeding the warning threshold （ P ＜0.05）. The area under the ROC curve of the model was 0.869 （95% confidence interval： 0.818-0.920）， with a sensitivity of 0.796 and a specificity of 0.842. The Hosmer-Lemeshow test showed good calibration （ P ＝0.570）. The calibration curve was closely aligned with the ideal curve， with a mean absolute error of 0.012. The model provided a higher net benefit across a threshold probability range of 6% to 82%. CONCLUSIONS The increased daily dose per kilogram of body weight， advanced age， concomitant coronary heart disease， elevated serum creatinine levels， concomitant use of amiodarone， and concomitant use of deslanoside are independent risk factors for SDC exceeding the warning threshold. The nomogram prediction model developed based on the aforementioned factors can be used to predict the risk of SDC exceeding the warning threshold.

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.

Bronchial asthma is a common chronic heterogeneous airway disease that is pathologically characterized by airway hyperresponsiveness and chronic inflammation.The pathogenesis of this disease is complex.Essentially,it is an airway inflammatory response driven by abnormal activation of the immune system.Its occurrence and development involve the participation of various immune cells and immune factors,including B lymphocytes,T lymphocytes,mast cells,macrophages and dendritic cells,as well as key cytokines such as interleukin(IL)-4,IL-5,IL-13,and interferon(IFN)-γ.And key cytokines such as interleukin(IL)-4,IL-5,IL-13 and interferon-γ.The complex interactions between these immune cells and mediators cause a series of pathological changes such as increased airway mucus secretion,smooth muscle contraction and airway remodeling,ultimately leading to the appearance of clinical symptoms,such as chest tightness,shortness of breath,wheezing and coughing.This article conducts systematically reviews current understanding of the immunological pathogenesis of bronchial asthma,thereby providing theoretical references for drug development and clinical diagnosis and treatment.

Objective To understand the current status and influencing factors of microbial contamination of dental unit waterlines(DUWLs)of secondary and lower medical institutions in Wuhan,and provide scientific basis for for-mulating prevention and control measures.Methods A stratified convenience sampling method was adopted to con-duct questionnaire survey on 248 dental medical institutions in 15 districts of Wuhan City,DUWLs from 44 medical institutions were sampled and detected according to hospital levels.Results Among disinfection and maintenance management measures for source water and waterlines,the highest implementation rate was the installation rate of anti-suction dental handpiece(73.39％,182/248),but only 16.48％(30/182)of institutions regularly conducted the detection on anti-suction function;The lowest was the daily disinfection rate of water storage tanks(17.53％,17/97).A total of 132 water specimens were collected from 44 medical institutions,with a qualified rate of microbi-al detection of 56.06％.The qualified rates for secondary,primary,and unclassified medical institutions were 77.78％,50.00％,and 50.72％,respectively,with statistically significant differences(P＜0.05).The qualified rates of microbial detection for source water,handpiece water,and three-way syringe water were 59.09％,50.00％,and 59.09％,respectively,with no statistically significant difference(P＞0.05).Univariate analysis re-sults showed that medical institutions that regularly conducted chemical disinfection on DUWLs,understood DU-WLs waterline cleaning and disinfection standards,regularly performed microbial monitoring on diagnosis and treat-ment water,qualified source water,and flushed waterlines for 3 minutes before and after daily consultations had a higher qualified rate of microbial detection in DUWLs diagnosis and treatment water,and the differences were all statistically significant(all P＜0.05).Conclusion The contamination status of DUWLs in secondary and lower medical institutions in Wuhan is relatively serious.It is recommended to focus on strengthening the training of rele-vant regulations,installing inlet filters,regularly detecting the anti-suction function of dental handpieces,imple-menting chemical disinfection and microbial monitoring on waterlines,standardizing the implementation of flushing before and after diagnosis and treatment,and strengthening the disinfection and use management of independent wa-ter storage tanks to control contamination.

Objective:To construct univariate and multivariate relapse free survival (RFS) prediction models for breast cancer patients with diabetes mellitus type 2 (T2DM) and to compare and select the model with higher predictive performance.Methods:A total of 912 breast cancer patients treated at the First Affiliated Hospital of Dalian Medical University from January 2010 to December 2016 were included, of which 202 patients had T2DM and 710 patients did not. Kaplan-Meier survival curve was drawn based on whether patients had T2DM, and log-rank test was performed based on whether patients had T2DM. All patients were randomly divided into a training set ( n=640) and a validation set ( n=272) at a ratio of 7∶3. Univariate and multivariate Cox proportional risk regression models were used to analyze RFS in breast cancer patients with the survival package. The "rms" package was employed to construct univariate and multivariate RFS prediction models for breast cancer patients with T2DM. Clinical decision curves and calibration curves were used to validate the models. The receiver operator characteristic (ROC) curve was used to compare and analyze the prediction performance of the two models. Results:There were no statistically significant differences between the training set and the validation set patients in terms of age, T2DM, surgical approach, axillary management methods, T stage, N stage, molecular sub-type, estrogen receptor (ER) 1, ER2, progesterone receptor (PR) , ER and PR consistency, Ki67, human epidermal growth factor receptor 2 (HER2) (all P>0.05) . There was a statistically significant difference in histological grade ( χ2=7.59, P=0.022) . Survival analysis showed that the 5-year RFS rate was 83.7% in patients with T2DM and 92.3% in patients without T2DM ( χ2=16.61, P<0.001) . Univariate analysis revealed that age ( HR=1.04, 95% CI: 1.03-1.06, P<0.001) , T2DM ( HR=2.31, 95% CI: 1.49-3.55, P<0.001) , surgical approach ( HR=2.39, 95% CI: 1.20-4.77, P=0.013) , axillary management methods ( HR=2.62, 95% CI: 1.72-3.98, P<0.001) , T stage (T 2: HR=2.13, 95% CI: 1.36-3.31, P<0.001; T 3: HR=6.90, 95% CI: 3.35-14.22, P<0.001) , N stage (N 2: HR=3.87, 95% CI: 2.12-7.07, P<0.001; N 3: HR=8.61, 95% CI: 4.71-15.75, P<0.001) , molecular sub-type (Luminal B: HR=2.74, 95% CI: 1.17-6.36, P=0.019; HER2 +: HR=3.64, 95% CI: 1.38-9.58, P=0.009; TNBC: HR=4.40, 95% CI: 1.71-11.34, P=0.002) , ER1 (>10%: HR=0.57, 95% CI: 0.37-0.90, P=0.016) , ER2 ( HR=0.57, 95% CI: 0.37-0.89, P=0.015) , and PR ( HR=0.56, 95% CI: 0.37-0.86, P=0.008) were all factors influencing RFS in breast cancer patients. Multivariate analysis demonstrated that age ( HR=1.04, 95% CI: 1.02-1.06, P<0.001) , T2DM ( HR=1.82, 95% CI: 1.16-2.85, P=0.009) , T stage (T 2: HR=1.60, 95% CI: 1.01-2.54, P=0.046; T 3: HR=2.64, 95% CI: 1.22-5.72, P=0.014) , N stage (N 2: HR=3.72, 95% CI: 2.01-6.88, P<0.001; N 3: HR=5.34, 95% CI: 2.78-10.25, P<0.001) , and ER1 (>10%: HR=0.63, 95% CI: 0.39-0.99, P=0.046) were independent factors influencing RFS in breast cancer patients. Based on the 10 and 5 variables with P<0.05 in the univariate and multivariate analyses respectively, the nomograms of the univariate and multivariate prediction models were constructed to evaluate the influence of factors such as T2DM on the postoperative RFS of breast cancer patients. Clinical decision curves and calibration curves indicated that both models had high predictive value for RFS in breast cancer patients, and the predictive results were highly consistent with the actual observed results. ROC curve analysis showed that there was no statistically significant difference in the area under the curve (AUC) of the two models for predicting the RFS rates of breast cancer patients in the training set and validation set at 36, 60, and 84 months (all P>0.05) , indicating that the predictive efficacy of the two models was comparable. The multivariate model is more suitable for clinical application because it uses fewer variables. Conclusions:Breast cancer patients with T2DM have poorer prognosis. Age, T2DM, T stage, N stage, and ER1 are independent factors influencing postoperative RFS in breast cancer patients. The multi-factor prediction model of RFS in breast cancer patients based on T2DM is more suitable for clinical application due to its higher predictive efficacy and fewer variables.

OBJECTIVE To understand the changing trends of use of antibiotics and etiological submission rates in medical institutions of Wuhan and find out the key points of management.METHODS The survey data of Wuhan were collected from the cross-sectional survey databases for nosocomial infections in China of 2016,2018,2020 and 2022,and the data were retrospectively analyzed.RESULTS From 2016 to 2022,a total of 141 284 hospital-ized patients from 117 medical institutions were enrolled in the survey,and the utilization rate of antibiotics was 32.36％;the utilization rate of antibiotics was 32.87％in 2016,31.74％in 2018,28.75％in 2020,34.56％in 2022,showing an upward trend(x2=13.941,P＜0.001).The utilization rates of antibiotics were relatively high in respiratory medicine department and comprehensive ICU,which showed upward trends(x2=16.377,P＜0.001;x2=5.581,P=0.018);the utilization rate of antibiotics showed a downward trend in non-neonates pediatrics de-partment(x2=11.886,P＜0.001).The rates of prophylactic use of antibiotics for type Ⅰ incision surgery were 31.54％,23.53％,28.44％and 13.24％,respectively,showing downward trends(x2=230.333,P＜0.001).The etiological submission rates were 59.98％,55.77％,65.69％and 59.16％,respectively,which were basically same(P=0.072);the etiological submission rates of the medical institutions with less than 300 beds and 300 to 599 beds showed upward trends,while the etiological submission rates of the medical institutions with 600 to 899 beds and no less than 900 beds showed downward trends(x2=42.019,P＜0.001;x2=4.599,P=0.032).The etiological submission rate was 44.87％in 2018 before the treatment with antibiotics,47.80％in 2020,44.45％in 2022,which were basically same(P=0.431);the etiological submission rate of the medical institutions with no less than 900 beds showed a downward trend(x2=14.464,P＜0.001).CONCLUSIONS The use of antibiotics of the hospi-talized patients is generally normalized in the medical institutions of Wuhan,the utilization rate shows an upward trend,the etiological submission rate is basically same,and the rate of prophylactic use of antibiotics for type Ⅰincision surgery shows a downward trend.It is necessary to attach great importance to the etiological submission of large scale metical institutions before the treatment with antibiotics and the use of antibiotic of some key departments.

Objective:To establish an evaluation index system for patient safety education targeted at undergraduate nursing interns.Methods:Based on the CIPP (Context, Input, Process, Product) evaluation model, a preliminary draft of the index system was developed using a literature review and semi-structured interviews. The Delphi method and the Analytic Hierarchy Process were applied to finalize the index system.Results:Two rounds of Delphi expert consultation were conducted. In the first round, 23 questionnaires were distributed, and 20 valid responses were received (effective response rate: 86.96%) . Among them, 15 experts (75.00%) provided revision suggestions. In the second round, 20 questionnaires were distributed, and 19 valid responses were received (effective response rate: 95.00%) , with two experts (10.53%) offering suggestions. The expert authority coefficients for the two rounds were 0.900 and 0.921, respectively. Kendall's coordination coefficients were 0.272 and 0.273 ( P<0.01) . The final evaluation system consisted of four first-level indicators, eight second-level indicators, and 18 third-level indicators. Conclusions:The evaluation index system constructed in this study is scientifically grounded and reliable. However, its practical utility and applicability require further validation.

Bronchial asthma is a common chronic heterogeneous airway disease that is pathologically characterized by airway hyperresponsiveness and chronic inflammation.The pathogenesis of this disease is complex.Essentially,it is an airway inflammatory response driven by abnormal activation of the immune system.Its occurrence and development involve the participation of various immune cells and immune factors,including B lymphocytes,T lymphocytes,mast cells,macrophages and dendritic cells,as well as key cytokines such as interleukin(IL)-4,IL-5,IL-13,and interferon(IFN)-γ.And key cytokines such as interleukin(IL)-4,IL-5,IL-13 and interferon-γ.The complex interactions between these immune cells and mediators cause a series of pathological changes such as increased airway mucus secretion,smooth muscle contraction and airway remodeling,ultimately leading to the appearance of clinical symptoms,such as chest tightness,shortness of breath,wheezing and coughing.This article conducts systematically reviews current understanding of the immunological pathogenesis of bronchial asthma,thereby providing theoretical references for drug development and clinical diagnosis and treatment.

Objective To understand the current status and influencing factors of microbial contamination of dental unit waterlines(DUWLs)of secondary and lower medical institutions in Wuhan,and provide scientific basis for for-mulating prevention and control measures.Methods A stratified convenience sampling method was adopted to con-duct questionnaire survey on 248 dental medical institutions in 15 districts of Wuhan City,DUWLs from 44 medical institutions were sampled and detected according to hospital levels.Results Among disinfection and maintenance management measures for source water and waterlines,the highest implementation rate was the installation rate of anti-suction dental handpiece(73.39％,182/248),but only 16.48％(30/182)of institutions regularly conducted the detection on anti-suction function;The lowest was the daily disinfection rate of water storage tanks(17.53％,17/97).A total of 132 water specimens were collected from 44 medical institutions,with a qualified rate of microbi-al detection of 56.06％.The qualified rates for secondary,primary,and unclassified medical institutions were 77.78％,50.00％,and 50.72％,respectively,with statistically significant differences(P＜0.05).The qualified rates of microbial detection for source water,handpiece water,and three-way syringe water were 59.09％,50.00％,and 59.09％,respectively,with no statistically significant difference(P＞0.05).Univariate analysis re-sults showed that medical institutions that regularly conducted chemical disinfection on DUWLs,understood DU-WLs waterline cleaning and disinfection standards,regularly performed microbial monitoring on diagnosis and treat-ment water,qualified source water,and flushed waterlines for 3 minutes before and after daily consultations had a higher qualified rate of microbial detection in DUWLs diagnosis and treatment water,and the differences were all statistically significant(all P＜0.05).Conclusion The contamination status of DUWLs in secondary and lower medical institutions in Wuhan is relatively serious.It is recommended to focus on strengthening the training of rele-vant regulations,installing inlet filters,regularly detecting the anti-suction function of dental handpieces,imple-menting chemical disinfection and microbial monitoring on waterlines,standardizing the implementation of flushing before and after diagnosis and treatment,and strengthening the disinfection and use management of independent wa-ter storage tanks to control contamination.

OBJECTIVE To understand the changing trends of use of antibiotics and etiological submission rates in medical institutions of Wuhan and find out the key points of management.METHODS The survey data of Wuhan were collected from the cross-sectional survey databases for nosocomial infections in China of 2016,2018,2020 and 2022,and the data were retrospectively analyzed.RESULTS From 2016 to 2022,a total of 141 284 hospital-ized patients from 117 medical institutions were enrolled in the survey,and the utilization rate of antibiotics was 32.36％;the utilization rate of antibiotics was 32.87％in 2016,31.74％in 2018,28.75％in 2020,34.56％in 2022,showing an upward trend(x2=13.941,P＜0.001).The utilization rates of antibiotics were relatively high in respiratory medicine department and comprehensive ICU,which showed upward trends(x2=16.377,P＜0.001;x2=5.581,P=0.018);the utilization rate of antibiotics showed a downward trend in non-neonates pediatrics de-partment(x2=11.886,P＜0.001).The rates of prophylactic use of antibiotics for type Ⅰ incision surgery were 31.54％,23.53％,28.44％and 13.24％,respectively,showing downward trends(x2=230.333,P＜0.001).The etiological submission rates were 59.98％,55.77％,65.69％and 59.16％,respectively,which were basically same(P=0.072);the etiological submission rates of the medical institutions with less than 300 beds and 300 to 599 beds showed upward trends,while the etiological submission rates of the medical institutions with 600 to 899 beds and no less than 900 beds showed downward trends(x2=42.019,P＜0.001;x2=4.599,P=0.032).The etiological submission rate was 44.87％in 2018 before the treatment with antibiotics,47.80％in 2020,44.45％in 2022,which were basically same(P=0.431);the etiological submission rate of the medical institutions with no less than 900 beds showed a downward trend(x2=14.464,P＜0.001).CONCLUSIONS The use of antibiotics of the hospi-talized patients is generally normalized in the medical institutions of Wuhan,the utilization rate shows an upward trend,the etiological submission rate is basically same,and the rate of prophylactic use of antibiotics for type Ⅰincision surgery shows a downward trend.It is necessary to attach great importance to the etiological submission of large scale metical institutions before the treatment with antibiotics and the use of antibiotic of some key departments.