OBJECTIVE To explore the effect of hydrogen peroxide disinfectant on terminal disinfection in wards of medical institutions.METHODS The surfaces of highly frequent contact objects of the wards of the First Affilia-ted Hospital of Nanchang University from which the public health center patients were discharged between Apr.2024 and Jun.2024 were respectively disinfected with 0.5％(low)and 5％(high)concentrations of hydrogen peroxide disinfecting wipes,totally 180 samples were randomly collected before and after the disinfection,and the pathogens were detected.The air of the wards from which the public health center patients were discharged be-tween Jul.2024 and Aug.2024 were disinfected with hydrogen peroxide dry mist disinfection device,and 90 sam-ples were respectively collected before and after the disinfection.Geobacillus stearothermophilus was used as the biological indicator and placed at various points within the air-disinfected wards to evaluate the disinfection level.The environmental sampling results and distribution of bacteria were observed and compared.RESULTS The qualified rates of disinfection of the object surfaces were 95.56％(86/90)and 98.89％(89/90)respectively for the low and high concentratioins of hydrogen peroxide disinfecting wipes,and there was no significant difference in the disinfection effect.Totally 120 strains of pathogens were isolated from unqualified samples before the disinfection,among which gram-negative bacteria(69.17％)were dominant,and the isolation rate of multidrug-resistant or-ganisms was 22.50％(27/120);only 1 strain of carbapenem-resistant Acinetobacter baumannii was isolated after the disinfection.The qualified rate of disinfection of air in the wards was 96.00％by 7.5％hydrogen peroxide dry mist disinfection device,the average bacterial colony counts in the air were 2 CFU/(5 min·vsl)after the dis-infection,and the killing rate of Geobacillus stearothermophilus was 100.00％by the air disinfection.CONCLUSION The hydrogen peroxide disinfectant can meet the requirement for terminal disinfection of the wards of the medical institutions,and it is portable and highly efficient.

Objective:To quantitatively evaluate the impact of hypothyroidism on renal function and address its underlying mechanisms using 99Tc m-diethylene triamine pentaacetic acid (DTPA) renal dynamic imaging. Methods:A total of 35 patients with differentiated thyroid cancer (12 males, 23 females, age (44.8±10.7) years), who were referred for radioiodine remnant ablation, were consecutively enrolled prospectively from October 2022 to October 2023 in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Serum examinations of thyroid- and renal function-relevant parameters and 99Tc m-DTPA renal dynamic imaging were performed before and 4 weeks after stopping taking levothyroxine ( L-T 4). Paired t test, Wilcoxon signed rank test and Wilcoxon rank sum test were used to analyze data. Results:After L-T 4 withdrawal, glomerular filtration rate (GFR) derived from renal dynamic imaging, estimated GFR (eGFR), and cystatin C level significantly decreased ((95.80±18.09) vs (89.86±15.58) ml/min; t=4.83, P<0.001; (108.27±18.39) vs (87.97±16.24) ml·min -1·1.73 m -2;t=9.37, P<0.001; (0.72±0.12) vs (0.64±0.15) mg/L; t=3.73, P=0.001). GFR decreased more robustly in male patients than in females (6.16(3.62, 14.89) vs 3.83(0.57, 8.25) ml/min; Z=-1.98, P=0.048). Additionally, 99Tc m-DTPA renal dynamic imaging revealed that the peak times of both left and right kidneys were significantly prolonged (3.03(2.53, 3.78) vs 3.04(2.53, 4.13) min; Z=-3.85, P<0.001; 3.14(2.46, 4.20) vs 3.50(2.74, 4.50) min; Z=-3.44, P=0.001), but the left and right renal half-excretion times remained stable ( Z values: -0.88, -0.48, P values: 0.381, 0.634). Conclusion:Based on the 99Tc m-DTPA renal dynamic imaging results, it can be demonstrated that hypothyroidism can lead to a significant decrease in renal function, and the possible reason might be the reduction in the blood perfusion of kidneys.

OBJECTIVE To explore the effect of hydrogen peroxide disinfectant on terminal disinfection in wards of medical institutions.METHODS The surfaces of highly frequent contact objects of the wards of the First Affilia-ted Hospital of Nanchang University from which the public health center patients were discharged between Apr.2024 and Jun.2024 were respectively disinfected with 0.5％(low)and 5％(high)concentrations of hydrogen peroxide disinfecting wipes,totally 180 samples were randomly collected before and after the disinfection,and the pathogens were detected.The air of the wards from which the public health center patients were discharged be-tween Jul.2024 and Aug.2024 were disinfected with hydrogen peroxide dry mist disinfection device,and 90 sam-ples were respectively collected before and after the disinfection.Geobacillus stearothermophilus was used as the biological indicator and placed at various points within the air-disinfected wards to evaluate the disinfection level.The environmental sampling results and distribution of bacteria were observed and compared.RESULTS The qualified rates of disinfection of the object surfaces were 95.56％(86/90)and 98.89％(89/90)respectively for the low and high concentratioins of hydrogen peroxide disinfecting wipes,and there was no significant difference in the disinfection effect.Totally 120 strains of pathogens were isolated from unqualified samples before the disinfection,among which gram-negative bacteria(69.17％)were dominant,and the isolation rate of multidrug-resistant or-ganisms was 22.50％(27/120);only 1 strain of carbapenem-resistant Acinetobacter baumannii was isolated after the disinfection.The qualified rate of disinfection of air in the wards was 96.00％by 7.5％hydrogen peroxide dry mist disinfection device,the average bacterial colony counts in the air were 2 CFU/(5 min·vsl)after the dis-infection,and the killing rate of Geobacillus stearothermophilus was 100.00％by the air disinfection.CONCLUSION The hydrogen peroxide disinfectant can meet the requirement for terminal disinfection of the wards of the medical institutions,and it is portable and highly efficient.

Objective:To quantitatively evaluate the impact of hypothyroidism on renal function and address its underlying mechanisms using 99Tc m-diethylene triamine pentaacetic acid (DTPA) renal dynamic imaging. Methods:A total of 35 patients with differentiated thyroid cancer (12 males, 23 females, age (44.8±10.7) years), who were referred for radioiodine remnant ablation, were consecutively enrolled prospectively from October 2022 to October 2023 in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Serum examinations of thyroid- and renal function-relevant parameters and 99Tc m-DTPA renal dynamic imaging were performed before and 4 weeks after stopping taking levothyroxine ( L-T 4). Paired t test, Wilcoxon signed rank test and Wilcoxon rank sum test were used to analyze data. Results:After L-T 4 withdrawal, glomerular filtration rate (GFR) derived from renal dynamic imaging, estimated GFR (eGFR), and cystatin C level significantly decreased ((95.80±18.09) vs (89.86±15.58) ml/min; t=4.83, P<0.001; (108.27±18.39) vs (87.97±16.24) ml·min -1·1.73 m -2;t=9.37, P<0.001; (0.72±0.12) vs (0.64±0.15) mg/L; t=3.73, P=0.001). GFR decreased more robustly in male patients than in females (6.16(3.62, 14.89) vs 3.83(0.57, 8.25) ml/min; Z=-1.98, P=0.048). Additionally, 99Tc m-DTPA renal dynamic imaging revealed that the peak times of both left and right kidneys were significantly prolonged (3.03(2.53, 3.78) vs 3.04(2.53, 4.13) min; Z=-3.85, P<0.001; 3.14(2.46, 4.20) vs 3.50(2.74, 4.50) min; Z=-3.44, P=0.001), but the left and right renal half-excretion times remained stable ( Z values: -0.88, -0.48, P values: 0.381, 0.634). Conclusion:Based on the 99Tc m-DTPA renal dynamic imaging results, it can be demonstrated that hypothyroidism can lead to a significant decrease in renal function, and the possible reason might be the reduction in the blood perfusion of kidneys.

Zuoguiwan， one of the classic formulas of traditional Chinese medicine （TCM）， has the effects of nourishing genuine Yin， supplementing essence， and replenishing marrow， and it is widely used in the clinical treatment of diseases caused by congenital essence deficiency. This article systematically reviewed the ancient books involving congenital deficiency and the modern research reports on the treatment of congenital deficiency with Zuoguiwan. From the formulation principle of Zuoguiwan and the TCM concept of congenital deficiency， this article discussed the theoretical basis of treating congenital deficiency with Zuoguiwan based on the modern research results. Ancient physicians have discovered that the deficiency of parents can lead to abnormal physical development and weakness of the offspring. ZHANG Jingyue divided congenital essence Qi into genuine Yin and primordial Yang and formulated Zuoguiwan based on the principle of Yin-Yang mutual assistance for supplementing congenital genuine Yin. Experimental studies have shown that Zuoguiwan can up-regulate the expression of connexin 43 （Cx43） protein and improve gap junction intercellular communication （GJIC） function to promote osteogenic differentiation and maturation of bone marrow mesenchymal stem cells and ameliorate abnormal bone development caused by congenital essence deficiency. Zuoguiwan can enhance the expression and activity of Reelin to ameliorate abnormal brain development. It can upregulate the expression of Cx43 protein to intervene in the phosphatidylinositol 3 kinase/protein kinase B （PI3K/Akt） pathway， thus repairing the reproductive functions. Zuiguiwan can promote the development and maturation of T cells and activate the Wnt/β-catenin signaling pathway in the thymus to improve immune functions. In addition， it can promote the expression of β-catenin and inhibit the expression of microtubule-associated proteins 1 light chain 3 （LC3） to attenuate skin dysfunctions. Moreover， Zuoguiwan can guide the differentiation of stem cells via the correlation between essence and vitality in TCM. Zuoguiwan has demonstrated significant therapeutic effects on some diseases in the pediatric， andrological， gynecological， geriatric， internal medicine， orthopedic and skin disease departments. On the basis of the results of experiments and clinical applications， this paper analyzes the specific connotation of congenital deficiency proposes that congenital deficiency should be subdivided into the four aspects of essence， Qi， Yin， and Yang. Congenital essence deficiency as the deficiency of genuine Yin can lead to deficiency of kidney essence in the offspring and dysfunction of kidney storing essence. Pharmacological studies have discovered that Cuscutae Semen， Lycii Fructus， and Achyranthis Bidentatae Radix in Zuoguiwan contain active components such as quercetin and kaempferol， which act on the targets such as recombinant prostaglandin endoperoxide synthase 2 （PTGS2）， interleukin-6 （IL-6）， mitogen-activated protein kinases （MAPK14）， tumor necrosis factor （TNF）， TP53， Vascular permeability factor A （VEGFA）， and albumin （ALB） to play a role in reproductive system development and hormone responses. Zuoguiwan has unique advantages over Liuwei Dihuangwan in nourishing congenital genuine Yin in the kidney and can achieve better therapeutic effects on the syndromes and diseases caused by congenital essence deficiency. This review is expected to enrich the knowledge about the efficacy and clinical application of Zuoguiwan， provide new perspectives and methods for the prevention and treatment of congenital deficiency and congenital essence deficiency， and give insights into the application of Zuoguiwan in modern healthcare， especially in the nurturing of offspring.

Opioid receptor agonist-antagonists are a class of drugs which have both agonistic and antagonistic effects on opioid receptors. These drugs already on the market mainly include pentazocine， butorphanol， nalbuphine， buprenorphine， dezocine and so on. Compared with pure opioid receptor agonists such as morphine and fentanyl， these drugs have strong analgesic effects， less addictive， and less side effects such as cough， itching and respiratory depression. Due to the different tendentious effects of opioid receptor agonists-antagonists among different endogenous opioid receptors （μ， κ， δ， etc.）， different receptors of subtypes can exhibit different or even opposite effects in terms of affecting emotions and drug dependence. Therefore， the rational use of these drugs can effectively reduce the occurrence of adverse reactions and drug abuse caused by opioid drugs. With the deepening of research on various endogenous opioid receptor subtypes and related drugs in the academic community， opioid receptor agonists- antagonists have broad application space and prospects in improving adverse reactions to opioid drugs and enhancing patient drug compliance.

Objective:To investigate the correlation between triglyceride-glucose (TyG) index and high on-treatment platelet reactivity (HTPR) during clopidogrel treatment in patients with ischemic stroke.Methods:Patients with ischemic stroke who received maintenance dose of clopidogrel (75 mg/d) in the Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine from January 2017 to March 2021 were retrospectively included. The highest quartile (Q4) of the TyG index was defined as insulin resistance. Platelet reactivity was assessed by thromboelastogram and clopidogrel HTPR was defined as the clot strength induced by adenosine diphosphate (MA ADP) >47 mm. Multivariate regression model was used to analyze the independent correlation between TyG index and platelet reactivity. Results:A total of 83 patients were included. The TyG index showed a linear correlation with MA ADP. The patients were divided into 4 groups according to the quartile of TyG index. The incidence of clopidogrel HTPR increased significantly with the increase of the quartile of the TyG index ( Ptrend=0.017). Multivariate analysis showed that there was a significant independent correlation between insulin resistance and clopidogrel HTPR (odds ratio 4.597, 95% confidence interval 1.285-16.446; P=0.019). Conclusions:In patients with ischemic stroke treated with clopidogrel, the incidence of clopidogrel HTPR gradually increases with the increase of the quartile of the TyG index. The insulin resistance assessed by the TyG index is independently associated with clopidogrel HTPR.

Essential palatal tremor is relatively rare in clinical practice, which manifests involuntary and rhythmic contraction of soft-palate along with auditory click. The cause is unknown and there is no specific treatment at present. This article reports a female patient with essential palatine tremor, who presented with involuntarily beating of soft palate, disappeared during sleep, had sensory tricks, and gradually developed mental and psychological problems such as anxiety disorders. After treatment with integrated traditional Chinese and Western medicine, the symptoms improved. The clinical features of the case were analyzed, relevant literature was reviewed, and the possible etiology and characteristics of the disease were explored, so as to provide reference for clinical diagnosis and treatment.

Objective To investigate the value of serum thyroglobulin (Tg) and antithyroglobulin antibody (TgAb) in differentiated thyroid carcinoma complicated with Hashimoto's thyroiditis after thyroid ablation.Methods Serum Tg and TgAb levels and the status of illness in 154 differentiated thyroid carcinoma patients with coexistent Hashimoto's thyroiditis and confirmed pathology after surgery followed by remnant ablation were performed during three years follow up.Tg and TgAb levels were assessed by chemiluminescent immunoassay assay.The cases were divided into three groups (according to the level of Tg):Tg ≤ 1 μg/L group,1 μg/L＜Tg ≤ 10 μg/L group and 10 μg/L＜Tg≤ 100 μg/L group.TgAb＞40 kIU/L was considered as positive,Cox's proportional hazard model was used to analyse prognostic value in different levels of Tg and TgAb for disease-free survival and recurrence.Results Compared with 1 μg/L＜Tg≤ 10 μg/L group and 10 μg/L＜Tg≤ 100 μg/L group,the relative risk in reflecting cancer recurrence (TgAb＞40 kIU/L) in Tg ≤ 1 μg/L group was 27.000 (95 ％ CI 6.727-108.374).The value of TgAb＞40 kIU/L in Tg≤ 1 μg/L group was greatly increased and highly correlated with metastasis.However,In the condition of Tg＞ 1 μg/L,the disease will be based on the level of TgAb.Conclusion The value of TgAb＞40 kIU/L in Tg ≤ 1 μg/L group seems to be the optimal cutoff value correlated with recurrence and metastasis of differentiated thyroid carcinoma.

Due to the subjective and objective constraints of universities in China,PBL Teaching Mode failed to gain its popularity in China's medical education.In its teaching reform,Guangzhou Medical University put forward a new teaching model--Web-based PBL Teaching Mode(hereinafter referred to as WPBL).by integrating the classical concept of PBL education with the real situation of the university and carried it out among students in bilingual classes of Clinical Medicine.The resuIts showed that by effectively overcoming the difficulties during the implementation of classical PBL teaching,Web-based PBL Teaching Mode not only succeeded in achieving the teaching objectives,but also improved the learning efficiency and utilization of teaching resources greatly by means of network technology.