OBJECTIVE To explore the lipid-regulating mechanism of the classic prescription Zexie Decoction on hyperlipidemia model mice.METHODS ELISA method was used to detect the four blood lipid indexes,liver function indicators and cholesterol acyltransferase levels in serum.HE and Oil Red O staining were used to determine the pathology of liver tissue.Network pharmacology was used to predict the lipid-lowering related targets of Zexie Decoction,and the GO function and KEGG pathway enrichment analyses of the intersection targets were realized.PCR chip technology was used to detect the target genes for network pharmacology screening,and qPCR and Western blot were used to detect gene and protein expression levels.RESULTS Zexie Decoction significantly regula-ted the four blood lipid indexes in hyperlipidemia model mice,improved the increase in liver damage indicators caused by high lipids,and had a reverse regulatory effect on the key enzymes HMGR and CYP7A1 of lipid metabolism and the lipid transporters ABCA1 and Apo-A1 in liver tissue.HE and Oil Red O staining showed that Zexie Decoction improved the pathological morphology of liver tissue,reduced lipid deposition in liver tissue,and significantly decreased the positive area ratio(P<0.01).The PCR chip obtained 44 re-verse-regulated genes,GO functional enrichment analysis obtained 266 entries,and KEGG pathway enrichment analysis screened 99 signaling pathways.The results of qPCR and Western blot showed that Zexie Decoction significantly downregulated the expression of PIK3CG,AKT1,and IL-6 genes(P<0.05,P<0.01),upregulated the expression of ABCG1 gene(P<0.05),downregulated PI3Kinase p110β,p-AKT(Ser473)and SREBP-1c protein expression levels(P<0.01),and reversely regulated miR21-5p(P<0.01).CONCLUSION Zexie Decoction has a significant regulatory effect on lipid metabolism in hyperlipidemia model mice and can improve liver damage caused by hyperlipidemia.Its lipid-regulating effect may be related to regulating cholesterol metabolism and transport in the body,and is closely linked to the miR21/PI3K-Akt/SREBP pathway.The lipid-regulating effect of the whole formula of Zexie Decoction is better than that of a single herb.

Objective:To explore the application effects of a new self-designed device for measuring postpartum blood loss in women with postpartum hemorrhage after vaginal delivery, so as to provide a basis for early identification and treatment of postpartum hemorrhage.Methods:The research was a quasi-experiment study. A total of 12 824 women who delivered vaginally in Women's Hospital of Nanjing Medical University from July 2021 to June 2022 were conveniently selected. Among them, the pregnant women enrolled from January to June 2022 were selected as the experimental group, and the pregnant women enrolled from July to December 2021 were included in the control group, with 6 412 cases in each group. The self-designed new postpartum blood loss measuring device was used to evaluate the blood loss in the experimental group, while the traditional blood collecting basin was taken in the control group.The differences between the two groups in the assessment error of 24 hours postpartum blood loss, postpartum blood loss at 2 hours and 24 hours, postpartum hemorrhage rate, severe postpartum hemorrhage rate and midwives′ satisfaction with the assessment of blood loss were compared.Results:The assessment error of 24 hours postpartum blood loss in the experimental group was 180.00 (80.00, 300.00) ml, which was lower than 192.00 (80.00, 310.00) ml in the control group, and the difference was statistically significant ( Z = - 2.04, P<0.05). The postpartum blood loss at 2 hours and 24 hours in the experimental group was 312.00 (290.00, 330.00) ml and 415.00 (385.00, 440.00) ml, respectively, which was higher than 310.00 (280.00, 330.00) ml and 407.00 (380.00, 435.00) ml in the control group, and the differences were statistically significant ( Z = - 9.86, - 5.42, both P<0.001). The rates of postpartum hemorrhage and severe postpartum hemorrhage in the experimental group were 6.50% (417/6 412) and 2.21% (142/6 412), respectively, higher than 4.71% (302/6 412) and 1.59% (102/6 412) in the control group, and the differences were statistically significant ( χ2 = 19.49, 6.69, both P<0.05). Midwives′ satisfaction score with the assessment of blood loss in the experimental group was (18.17 ± 1.02) points, higher than that in the control group (17.78 ± 1.17) points, and the difference was statistically significant ( t = 2.33, P<0.05). Conclusions:The use of a new device for measuring postpartum bleeding during vaginal delivery can reduce errors in evaluating postpartum blood loss within 24 hours, improve the detection rate of postpartum hemorrhage and severe postpartum hemorrhage, and midwives are satisfied with it.

Objective The aim of this study was to investigate the effects of general practice mode combined with duloxetine on psychological status,sleep quality and serum inflammatory cytokines in patients with Fibromyalgia Syndrome(FMS).Methods A total of 105 FMS patients in Chengde Central Hospital from January 2019 to December 2021 were divided into the combined group(53 cases)and the control group(52 cases)by the random number table method.The two groups were treated with general practice mode combined with duloxetine or duloxetine alone.The single course of treatment lasted for 4 weeks.Their efficacy and safety were evaluated after 2 courses of intervention.Visual analogue scale(VAS),Hamilton Anxiety assessment scale(HAMA),Hamilton Depression Scale(HAMD)and Pittsburgh Sleep Quality Index(PSQI)were performed before and after treatment.The pain,psychological status and sleep quality of the patients were evaluated.Blood samples were taken to measure the serum levels of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1)and IL-6 before and after treatment.Results The total effective rate in the study group was 96.23%,which was higher than that in the control group(82.69%,P<0.05).Compared with those before treatment,VAS,HAMA,HAMD and PSQI scores,serum TNF-α,IL-1 and IL-6 levels in the two groups were all decreased after treatment,and those in the study group were lower than those in the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between two groups(7.55%vs.19.23%,P>0.05).Conclusion General practice mode combined with duloxetine was safe and effective in the treatment of FMS,which could significantly relieve anxiety and depression of patients,improve their sleep quality,and reduce the level of serum inflammatory cytokines.

OBJECTIVE To evaluate the econo mical efficiency of ensatinib i n the first-line treatment of anaplastic lymphoma kinase（ALK）positive-advanced non-small cell lung cancer （NSCLC），so as to provide reference for China ’s medical insurance decision-making and rational drug use in clinic. METHODS A three-state partitioned survival model was constructed from the perspective of China ’s health system ，based on the data of the international multi-center phase Ⅲ clinical trial （eXalt3 trail），with simulation time limit of 10 years，cycle period of 30 days. The economical efficiency of ensatinib was compared with that of crizotinib（standard treatment ）in the first-line treatment of ALK positive-advanced NSCLC. The incremental cost-effectiveness ratio （ICER） was calculated with quality-adjusted life years （QALYs） as utility index. The stability of basic analysis results was validated through uncertainty analysis. RESULTS The basic analysis results showed that compared with crizotinib group ， incremental cost per capita of ensatinib group was －343 370.36 yuan，incremental utility per capita was 0.76 QALYs，ICER was －454 292.25 yuan/QALY，which was far lower than the willingness-to-pay （WTP）threshold of 1 time of China ’s per capita gross domestic product （GDP，80 976 yuan）in 2021. The results of univariate sensitivity analysis showed that progression-free survival （PFS）status utility ，progression of disease （PD）status utility and subsequent treatment cost of crizotinib had a greater impact on ICER，but these parameters could not cause the reversal of basic analysis results. Probabilistic sensitivity analysis showed that with 1 time of China ’s per capita GDP in 2021 as the WTP threshold ，the probability of ensatinib group ’s treatment possessed economical efficiency was 100％. In the situational analysis ，ICER obtained by changing the ensatinib group ’s follow-up treatment regimen was －217 671.43 yuan/QALY，which was far below WTP threshold. CONCLUSIONS For Chinese patients with ALK positive-advanced NSCLC ，compared with commonly used the first-line treatment （crizotinib），ensartinib is economical and absolutely dominant.

Objective:To explore the expression of caveolin-1 (Cav-1) and Chitinase-40 (YKL-40) in acute cerebral infarction and the value of combined detection in prognosis evaluation.Methods:118 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Hebei Northern University from January 2016 to June 2019 were selected as the research objects. According to the cerebral infarction volume, the patients were divided into small infarction group (<5 cm 3), middle infarction group (5-10 cm 3) and large infarction group (>10 cm 3). 108 healthy people were selected as the healthy control group. The serum levels of Cav-1 and YKL-40 were compared in the 3 groups, and the correlation between the degree of cerebral infarction and serum levels of Cav-1 and YKL-40 was analyzed. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of the expression levels of Cav-1 and YKL-40 in patients with acute cerebral infarction; the patients were followed up for one year and the prognosis was evaluated by modified Rankin Scale (mRS); the correlation between serum Cav-1 and YKL-40 and prognosis was analyzed. Results:The expression levels of serum Cav-1 and YKL-40 in patients with acute cerebral infarction were significantly higher than those in healthy group ( P<0.001). The serum levels of Cav-1 and YKL-40 were positively correlated with the infarct volume of acute cerebral infarction ( r=0.854, P=0.004; r=0.867, P=0.002). ROC curve analysis showed that the sensitivity, Youden index and area under ROC curve of Cav-1 (21.78 μg/L) combined with YKL-40 (158.69 ng/ml) in the diagnosis of acute cerebral infarction were 85.59%, 0.532 and 0.896 (95% CI: 0.741-0.932), respectively, which were significantly higher than those of single index ( P<0.05). At 8 and 12 months of follow-up, the proportion of death and mRS score in the positive group were significantly higher than those in the negative group ( P<0.05). Conclusions:The serum Cav-1 and YKL-40 levels are significantly higher in patients with acute cerebral infarction. The combined examination of Cav-1 and YKL-40 can improve the diagnostic efficiency and has potential application value for early diagnosis and prognosis prediction of patients.

Objective:To explore the correlation between sleep duration and incident diabetes among residents of different ages in Xinjiang region.Methods:A total of 9 541 residents, aged 40 and over in Karamay, Xinjiang were identified by a cluster sampling method. Physical examinations and biochemical test were performed, and the data on sleep duration and lifestyle were obtained using standardized questionnaires. The population was divided into three categories according to sleep duration: insufficient sleep(<6 h), ideal sleep(6-8 h), and long sleep duration(>8 h). They were further divided into 2 subgroups based on age at survey. Those who were younger than 60 years old were defined as the middle-aged group, and the rest as the elderly. Multivariate logistic regression analysis was used to explore the correlation between sleep duration and the risk of diabetes in different age groups.Results:There existed an approximate U-shaped relationship between total sleep duration and fasting blood glucose as well as HbA 1C. Fasting blood glucose and HbA 1C were relatively lower among those with ideal sleep duration. After multivariable adjustment, residents with insufficient sleep revealed a 35% increased risk of diabetes( OR=1.35, 95% CI 1.06-1.71) compared with those with ideal sleep duration. However, the risk of diabetes was not significantly increased in those with long sleep duration( OR=1.04, 95% CI 0.94-1.14). Furthermore, the additive risk of insufficient sleep was only significant in the middle-aged group( OR=1.37, 95% CI 1.02-1.84). Conclusions:Among residents of different ages in Xinjiang region, insufficient sleep is associated with an increased risk of diabetes, which is only significant in the middle-aged group.

OBJECTIVE：To evaluate the econo mics of pembrolizumab in the second-line treatment of advanced hepatocellular carcinoma in China. METHODS ：From the perspective of Chinese healthcare system ，a three-state PartSA model and Markov model were established ；the cost and utility for the second-line treatment of advanced hepatocellular carcinoma in China were compared between pembrolizumab and placebo. The circulation cycle of the model was 3 weeks and the study time limit was lifetime；one-way sensitivity analysis ，probability sensitivity analysis and scenario analysis were used to verify the robustness of the base-case analysis results. RESULTS ：PartSA results showed that the ICER for the second-line treatment of advanced hepato- cellular carcinoma with pembrolizumab was 1 266 846.18 yuan/QALY，which is far more than 1-3 times of China ’s per capita GDP in 2020. The results of one-way sensitivity analysis showed that the three parameters that had the greatest impact on ICER were the PFS status utility of the placebo group ，the PFS status utility of the pembrolizumab group ，and the cost of pembrolizumab. The results of probability sensitivity analysis verified the robustness of the base-case analysis. The scenario analysis showed that the treatment cost of pembrolizumab had dropped significantly when the charity donation of pembrolizumab was considered. Although it was still not economical ，ICER was close to 3 times of per capita GDP of China in 2020. When WTP threshold was 1 and 3 times of China ’s per capita GDP ，the economic prices of pabolizumab （100 mg）were 4 157.67 and 5 829.24 yuan，respectively. The results of Markov model were similar to those of PartSA model. CONCLUSIONS ：Under the WTP threshold of 1-3 times China ’s per capita GDP in 2020，pembrolizumab is not economical for second-line treatment of advanced hepatocellular carcinoma.

Objective To investigate the effects of different umbilical cord ligation methods on anemia and jaundice in preterm infants with a gestational age less than 32 weeks.Methods A total of 135 preterm infants with a gestational age less than 32 weeks were recruited and randomly divided into the umbilical cord milking group,the delayed cord clamping group and the immediate cord clamping group,with 45 cases in each group.Comparisons among three groups were performed on hemoglobin,hematocrit at 1 h and 1 week after birth,and bilirubin peak,total time of phototherapy,the incidence of anemia,pathologic jaundice as well as polycythemia before discharge.Results Finally 40 cases in the umbilical cord milking group,42 cases in the delayed cord clamping group and 38 cases in the immediate cord clamping group were recruited.Compared with the immediate cord clamping group,Hb(g/L)and hematocrit(％) levels were significantly higher in the umbilical cord milking group and the delayed cord clamping group(P＜0.05),the anemia rate was significantly lower in umbilical cord milking group and the delayed cord clamping group(P＜0.05).However,there were no statistical differences in Hb(g/L) and hematocrit(％) levels as well as ane mia rate between the umbilical cord milking group and the delayed cord clamping group (P＞0.05).There were no significant differences among three groups in bilirubin peak,total time of phototherapy and the incidence of pathologic jaundice as well as polycythemia.Conclusion Umbilical cord milking and delayed cord clamping can both reduce the anemia rate,but not increase the risk of pathological jaundice.Umbilical cord milking can be preferred method for preterm infants with a gestational age less than 32 weeks and asphyxia.

Objective To construct the nursing quality sensitive index of midwifery applicable for delivery room, so as to provide a basis for evaluating and monitoring nursing quality of delivery room. Methods The literature review was used to preliminarily draw up the sensitive indicators framework. Delphi method involved with internal enquiry and experts enquiry was used to define the key content and measuring methods. Results The experts' authority coefficient was higher than 0.80 and the coefficient of variation of the index was lower than 0.30. We constructed a nursing quality sensitive index system of midwifery including three first-level indicators and 16 second-level indicators by two rounds of expert consultation. Conclusions The nursing quality sensitive index of midwifery based on Delphi method is with sensibility, scientific nature and practicability which can promote the sustained development of delivery room.

Objective To investigate the status quo of knowledge-attitude-practice in preventing venous thromboembolism (VTE) among medical staff in Shandong Province and analyze the influencing factors, so as to provide guidance for the prevention and treatment of VTE. Methods In November 2017, 1 987 medical staff from 52 hospitals in Shandong Province were investigated by filling out an electronic questionnaire with a self-designed questionnaire on knowledge, attitude and behavior related to VTE prevention among medical staff. Results The knowledge score on VTE prevention of medical staff was (19.49±2.33), attitude score (21.82±2.55), practice score (64.87±9.54), respectively accounted for 88.59%, 87.28% and 81.09%. The total scores of knowledge, belief and practice of VTE prevention among medical staff in different hospital grades, occupations, educational background, professional titles and departments were statistically significant (F=9.419, 8.418, 2.823, 6.852, 6.375; P＜ 0.05). Conclusions Medical staff have a higher level of knowledge and attitude towards prevention of VTE, but lack of behavioral knowledge. The hospital should establish a standardized VTE prevention and management system to raise the level of VTE prevention and control.