Objective:To explore the potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer and analyze the influencing factors, so as to provide theoretical basis for implementing precise interventions of occupational rehabilitation.Methods:This was a cross-sectional study. A convenient sampling method was used to select 257 postoperative patients with thyroid cancer in Zhujiang Hospital of Southern Medical University from May 2022 to July 2023. The General Information Questionnaire, Return-To-Work Self-Efficacy Questionnaire and Cancer Fatigue Scale were used for investigation. Latent profile analysis was used to explore the potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer. Logistic regression and decision tree were used to analyze the influencing factors of different potential categories.Results:Finally, 250 postoperative patients with thyroid cancer were included. There were 76 males and 174 females, aged (37.91 ± 8.04) years old. The return-to-work self-efficacy of postoperative patients with thyroid cancer was divided into 2 potential categories: low return-to-work self-efficacy group (72.0%, 180/250) and high return-to-work self-efficacy group (28.0%, 70/250). Logistic regression showed education, thyrotropin suppressive therapy, cancer-related fatigue and age were factors influencing the potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer ( OR values were 0.951 - 19.820, all P<0.05). Decision tree model showed education level and cancer-related fatigue were the most important factors ( χ2 = 31.40, 16.95, both P<0.05). Conclusions:There were two potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer. Most of them had low levels of return-to-work self-efficacy. Health care professionals should focus on patients who are less educated and having cancer-related fatigue, meanwhile, should not ignore patients who are substandard thyrotropin suppressive therapy, and older. Implement precise interventions of occupational rehabilitation to improve the return-to-work self-efficacy of postoperative patients with thyroid cancer so as to help them reintegrate into society.

Objective:To investigate the impact of programmed death receptor-1(PD-1)and its ligand(PD-L1)on the differentiation of decidual macrophages(DMs)and embryonic development.Methods:20 patients with re-current spontaneous abortion(RSA group)and 20 patients with normal pregnancy induced artificial abortion(NP group)were selected from Sichuan Provincial People's Hospital between March 2021 and January 2024.Villous and decidual tissues were obtained from both groups.Real-time fluorescent quantitative polymerase chain reac-tion(qPCR)and Western blot techniques were used to detect the expression of PD-L1 mRNA and protein in vil-lous tissues.Flow cytometry was used to analyze the types of DMs and their PD-1 expression.Human monocytic leukemia cells(THP-1)were differentiated under different conditions,with a control group and a PD-1 blocked group established,and different reagents were added into those two groups to induce differentiation,then the pro-portion of DMs types was measured in both groups.Results:PD-L1 protein and mRNA were expressed in the vil-lous tissue of both groups of patients but the expression of PD-L1 protein and mRNA was reduced in the RSA group compared to the NP group(P<0.05).The decidual tissues of both groups contained M1 and M2 macro-phages.Compared with the NP group,the ratio of M2 to M1 DMs in the RSA group was lower(P<0.05),indica-ting a polarization towards the M1 type in DMs.There was no statistically significant difference in PD-1 expression between the two groups(P>0.05).Human THP-1 cells can be stimulated to differentiate into M1 and M2 macro-phages.Afterblocking PD-1,theratioof M2 to M1 macrophages decreased(P<0.05),indicating a polarization towards the M1 type in macrophages.Conclusions:In patients with RSA,the expression of PD-L1 in villous tis-sues is decreased,and DMs polarize towards the M1 type.Blocking the PD-1/PD-L1 pathway can further promote the polarization of macrophages towards the M1 type.The influence of PD-1/PD-L1 pathway on macrophage po-larization may provide new insights into the pathogenesis of RSA.

Objective To observe the clinical efficacy and safety of ticagrelor tablets combined with atorvastatin calcium tablets in the treatment of cerebral thrombosis.Methods The patients with cerebral thrombosis were divided into control group and treatment group according to cohort methods.Two groups were given basic therapy.On the basic therapy,control group was given atorvastatin calcium 20 mg per time,once a day,orally;on the basic of control group,the treatment group received ticagrelor 90 mg per time,twice a day,orally.Two groups were treated for 4 months.The clinical efficacy,nerve function,blood viscosity,platelet parameters,brain injury markers and adverse drug reactions were compared between two groups.Results Treatment and control groups enrolled 119 and 117 cases,respectively.After treatment,the total effective rates of treatment and control groups were 91.60％(109 cases/119 cases)and 82.05％(96 cases/117 cases)with significant difference(P＜0.05).After treatment,the scale scores of treatment and control groups were(5.47±0.82)and(6.51±0.96)points;the plasma viscosity levels were(1.35±0.21)and(1.62±0.24)mPa·s,whole blood high shear viscosity levels were(3.67±0.51)and(4.01±0.59)mPa·s;the whole blood low shear viscosity levels were(6.12±0.93)and(7.05±1.07)mPa·s;the platelet adhesion rates were(30.52±3.81)％and(36.21±4.02)％;the mean platelet volumes were(12.75±1.86)and(15.42±2.06)fL;the carboxy-terminal hydrolase of ubiquitin levels were(0.39±0.06)and(0.51±0.07)μg·L-1;the key protein antigen-5 of aging levels were(90.76±12.23)and(81.64±11.95)μg·L-1;and the differences were statistically significant between two groups(all P＜0.05).The adverse drug reactions of two groups were nausea,vomiting,bleeding,abdominal pain and diarrhea.The total incidences of adverse drug reactions in treatment and control groups were 5.04％and 4.27％,without significant difference(P＞0.05).Conclusion Ticagrelor tablets combined with atorvastat in calcium tablets have a significant clinical efficacy in the treatment of patients with cerebral thrombus,which can significantly improve the neurological function,blood viscosity,brain injury markers,and platelet parameters of patients,without increasing the incidence of adverse drug reactions.

Objective To investigate the effect of pachymic acid(PA)on HIEC-6 inflammatory response of intestinal epithelial cells infected by Fusobacterium nucleatum(Fn)and its possible mechanism.Methods HIEC-6 cells were divided into control group,model group(1× 108 CFU·mL-1 Fn infection),experimental-L group(1× 108 CFU·mL-1 Fn+2 μmol·L-1 PA),experimental-M group(1× 108CFU·mL-1 Fn+4 μmol·L-1 PA),experimental-H group(1× 108 CFU·mL-1 Fn+8 μmol·L-1 PA),pcDNA-TLR4 group(1 × 108 CFU·mL-1 Fn+8 μmol·L-1 PA+transfected pcDNA-TLR4).After 12 h of treatment,the cell proliferation was detected by cell counting kit-8(CCK-8)test and Edu test respectively.The expression of inflammatory cytokines was detected by enzyme-linked immunosorbent assay(ELISA)and real-time quantitative polymerase chain reaction(RT-qPCR)respectively.The apoptosis was detected by flow cytometry.Western blot assay was used to detect the expression level of cell related proteins.Results The apoptosis rates of control,model,experimental-L,experimental-M,experimental-H and pcDNA-TLR4 groups were(3.51±0.31)％,(23.38±1.85)％,(16.74±0.54)％,(12.10±1.44)％,(8.89±0.63)％and(14.87±0.88)％,respectively;IL-8 content were(23.25±1.41),(79.69±4.37),(68.94±2.63),(51.46±2.56),(34.18±2.63)and(71.09±5.08)pg·mL-1,respectively;IL-1β contents were(8.81±0.49),(51.65±2.13),(35.98±3.47),(24.83±2.47),(14.79±1.25)and(43.89±1.59)pg·mL-1.Compared between model group and control group,compared between experimental-L,experimental-M,experimental-H groups and model group,compared between pcDNA-TLR4 group and experimental-H group,the differences of the above indexes were all statistically significant(all P＜0.05).Conclusion Pachymaric acid may improve the apoptosis of Fn infected intestinal epithelial cells by inhibiting TLR4/NF-κB pathway and inflammatory response.

Objective To explore the protective mechanism of baicalin regulating NOD like receptor thermal protein domain associated protein 3(NLRP3)inflammasomes against acne.Methods Compound acne models were prepared by intradermal injection of Propionibacterium acnes into the auricle.Rats were randomly divided into control group(normal rats were given physiological saline by gavage),model group(acne model rats were given physiological saline by gavage),experimental-L,-M,-H groups(acne model rats were given 25,50,and 100 mg·kg-1 of baicalin by gavage),and positive control group(acne model rats were given 3.125 mg·kg-1 of isotretinoin by gavage),with 10 rats in each group.Observe the morphology of rat auricles;enzyme linked immunosorbent assay(ELISA)was used to detect the level of inflammation in serum;hematoxylin-eosin staining was used to detect pathological changes in rat auricle tissue;Western blotting was used to detect the protein expression level in the auricle tissue.Results After drug treatment,the auricular thickness of rats in the control,model,experimental-H and positive control groups were(0.42±0.05),(0.75±0.10),(0.49±0.05)and(0.50±0.05)mm;the serum levels of tumor necrosis factor-α were(20.46±2.13),(62.32±5.47),(23.27±2.26)and(25.41±2.28)pg·mL-1;interleukin-1 β levels were(11.38±1.26),(31.62±2.58),(15.61±1.35)and(16.72±1.38)pg·mL-1;interleukin-6 levels were(10.62±1.02),(25.43±2.51),(13.27±1.15)and(14.01±1.17)pg·mL-1;NLRP3 protein expression levels in auricular tissues were 0.23±0.03,0.81±0.08,0.30±0.04 and 0.32±0.04;and Caspase-1 protein expression levels were 0.31±0.04,0.76±0.08,0.39±0.04 and 0.41±0.04;matrix metalloproteinase-2 protein expression levels were 0.35±0.04,0.86±0.10,0.40±0.05 and 0.42±0.05.Compared with the model group,the above indexes in the experimental-H group were statistically significant(all P＜0.05).Conclusion Baicalin can inhibit the inflammatory response in acne rats,and its mechanism of action may be related to the inhibition of the NLRP3 inflammasome signaling pathway.

ObjectiveTo retrospectively analyze the clinical efficacy of Xibining Ⅱ prescription in the treatment of knee osteoarthritis with cold-dampness blockage syndrome by oral medication and to explore the influencing factors of endpoint events. MethodA real-world retrospective cohort design was adopted， and medical records of knee osteoarthritis patients with cold-dampness blockage syndrome treated with oral medication from the orthopedics outpatient department of Jiangsu Province Hospital of Chinese Medicine were collected. All patients received conventional Western medicine treatment and were divided into non-exposure group （573 cases） and exposure group （427 cases） according to whether or not they received treatment with Xibining Ⅱ prescription. Descriptive analysis of the baseline data of the 1 000 screened cases was performed using IBM SPSS 27.0. According to the baseline data， 334 pairs were matched using the propensity score matching method， resulting in a total of 668 cases in both groups. The changes in visual analogous scale （VAS）， Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） total score， Japanese Knee Osteoarthritis Measure （JKOM） score， and traditional Chinese medicine （TCM） syndrome score before treatment and at 2， 6， 12 weeks after treatment， as well as the incidence of adverse reactions， were compared between the two groups. A multivariate logistic regression analysis was conducted to analyze the influencing factors of endpoint events， with clinical cure judged based on the improvement rate of WOMAC total score before and after treatment. ResultAfter 12 weeks of treatment， compared to the results before treatment， the VAS， WOMAC total score， JKOM score， and TCM syndrome score of patients in both groups significantly decreased （P<0.01）. Compared to the non-exposure group， the exposure group showed a more significant reduction in VAS， WOMAC total score， JKOM score， and TCM syndrome score （P<0.01）. After 12 weeks of treatment， the clinical cure rate and significant efficiency were higher in the exposure group than in the non-exposure group （P<0.05）. Compared to the results before treatment within each group， VAS， WOMAC pain， stiffness， function scores， JKOM score， and TCM syndrome score significantly decreased at 2， 6， 12 weeks after treatment in both groups （P<0.01）. Compared to the non-exposure group at the same time points， the exposure group showed a reduction in VAS at 2， 12 weeks， WOMAC pain at 6， 12 weeks， and function scores at 12 weeks （P<0.05， P<0.01）. The JKOM score decreased at 6， 12 weeks， and the TCM syndrome score significantly decreased at 2， 6， 12 weeks in the exposure group （P<0.05， P<0.01）. Multivariate logistic regression analysis at 12 weeks showed that factors affecting clinical cure included the course of disease， history of alcohol consumption， hypertension， coronary heart disease， and the use of Xibining Ⅱ prescription （P<0.05， P<0.01）. Compared to the non-exposure group at the same time points， the incidence of epigastric discomfort in the exposure group was lower at 2， 12 weeks （P<0.01）， the incidence of diarrhea and vomiting was slightly higher than that in the non-exposure group， but the difference was not statistically significant. ConclusionThe clinical application of Xibining Ⅱ prescription combined with conventional Western medicine treatment in the treatment of knee osteoarthritis with cold-dampness blockage syndrome is more effective than conventional Western medicine treatment alone. It can significantly reduce VAS， WOMAC total score， JKOM score， and TCM syndrome score， with more pronounced long-term effects and a low incidence of adverse reactions.

Objective To analyze the status of the bacteria in the operative area of transnasal skull base surgery and its correlation with postoperative intracranial infection.Methods The procedure of transnasal skull base surgery was divided into three stages:nasal passage preparation(stage 1),tumor resection(stage 2),and skull base reconstruction(stage 3).Bacterial sampling was taken from the mucosa of the anterior wall of sphenoid sinus or clival recess of sellar floor at the beginning of each stage;and the positive rate of bacterial culture in different stages of operation and its correlation with postoperative intracranial infection were analyzed.Results A total of 105 patients were enrolled in this study,and 315 samples were taken.The average time point of sampling in the three stages was 20.3,45.1 and 131.3 min after the beginning of operation,respectively.The positive results were 9 cases(2.9％)in the stage 1,8 cases(2.5％)in the stage 2,and 23 cases(7.3％)in the stage 3,which were 24 cases of Staphylococcus epidermidis,7 cases of Staphylococcus aureus,3 cases of hemolytic streptococcus,2 cases of Klebsiella pneumonia,and 4 cases of Escherichia coli.There was no significant difference in the positive cases between stage 1 and stage 2(P=0.955),but there were significant differences between stage 1 or 2 and stage 3(P=0.013;P=0.007).There were 36(11.4％)patients with at least one positive result in the three stages,17(16.2％)with cerebrospinal fluid leakage,and 12(11.4％)with intracranial infection.The risk of intracranial infection was 3.1 times higher in patients with positive bacterial culture than patients with negative bacterial culture(OR=3.1,95％CI:0.9-10.6),which was not statistically significant;patients with CSF leakage were 61.4 times higher than those without CSF leakage(OR=61.4,95％CI:11.2-337.1),which was statistically significant(P＜0.001).The consistency rate of bacteria in nasal cavity and postoperative cerebrospinal fluid culture was 57.1％.Conclusion The positive rate of bacterial culture in the operative area of transnasal skull base surgery increases significantly with the extension of operation time,which is a potential risk index of postoperative intracranial infection.

The mutual recognition of medical examination results is significant for improving the utilization efficiency of limited resources in large public hospitals,promoting the sharing of quality medical resources,alleviating the high costs and diffi-culties of healthcare for the public,reducing pressure on medical insurance funds,and enhancing the efficiency of fund utiliza-tion.This study reviews the research on mutual recognition of medical examination results in China,analyzing it from four as-pects:regulatory norms,platform construction,policy awareness,and performance distribution.It identifies research hotspots and directions related to mutual recognition,clarifies the challenges and key points in the implementation of relevant policies,and suggests future research directions,including strengthening theoretical research,improving empirical studies,and innovating re-search methods.

Objective:To explore the predictive value of peripheral blood neutrophil to lymphocyte ratio (NLR) and serum trimethylamine oxide (TMAO) on in-hospital mortality events in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) upon admission.Methods:A retrospective collection of medical records of 103 AMICS patients admitted to the Shanxi Yingkang Life General Hospital from January 2018 to June 2023 was conducted. The patients were divided into a survival group ( n=78) and a death group ( n=25) based on whether they experienced in-hospital mortality events. Two groups of peripheral blood NLR, serum TMAO, baseline data, and other laboratory indicators were compared. A logistic regression model was used to analyze the risk factors for in-hospital mortality in AMICS patients and a prediction model was constructed. We established receiver operating characteristic (ROC) curves to evaluate the predictive efficacy of peripheral blood NLR, serum TMAO, peripheral blood NLR+ serum TMAO, and predictive model indicators for in-hospital mortality events in AMICS patients. Results:The peripheral blood NLR and serum TMAO levels in the death group were significantly higher than those in the survival group (all P<0.05). The age of the death group was higher than that of the survival group, and the proportion of hypertension, alanine aminotransferase, creatinine, random blood glucose, proportion of patients who did not receive emergency percutaneous coronary intervention (PCI) treatment, peak cardiac troponin I, B-type natriuretic peptide, Gensini score of coronary artery disease, and C-reactive protein were all higher than those of the survival group. Systolic blood pressure and platelet count were lower than those of the survival group, heart rate and erythrocyte sedimentation rate were faster than those of the survival group, and the pre hospital time was longer than that of the survival group. The differences were statistically significant (all P<0.05). The results of binary logistic regression analysis showed that after adjusting for confounding factors such as age, male proportion, body mass index, proportion of old myocardial infarction, proportion of hypertension, and proportion of PCI history, advanced age, long pre hospital time, failure to receive emergency PCI, elevated peripheral blood NLR, and elevated serum TMAO were independent risk factors for in-hospital mortality in AMICS patients ( P<0.05). The predictive model was obtained as 0.734×age+ 0.277×pre hospital time+ 2.263×failure to receive emergency PCI+ 0.549×peripheral blood NLR+ 0.608×serum TMAO-26.923. The ROC curve results showed that the area under the curve (AUC) values of peripheral blood NLR, serum TMAO, peripheral blood NLR+ serum TMAO, and predictive model indicators for predicting in-hospital mortality events in AMICS patients were 0.744, 0.781, 0.825, and 0.921, respectively. When the optimal cutoff value was taken, the sensitivities were 0.880, 0.520, 0.680, and 0.880, and the specificities were 0.526, 0.923, 0.872, and 0.821, respectively. Conclusions:Advanced age, long pre hospital duration, failure to undergo emergency PCI, elevated peripheral blood NLR, and elevated serum TMAO are independent risk factors for in-hospital mortality in AMICS patients. Peripheral blood NLR, serum TMAO, peripheral blood NLR+ serum TMAO, and prediction models all have certain predictive value for in-hospital mortality events in AMICS patients. Among them, the sensitivity and specificity of the prediction models are high, and the efficacy is good.

Objective To evaluate the incidence rate of Duchenne muscular dystrophy(DMD)in the male newborns in the Ningxia region and establish a critical threshold for screening DMD in newborns to distinguish between the normal population and affected individuals.Methods A total of 10 000 male newboms were screened using immunofluorescence analysis of creatine kinase isoenzyme concentrations in heel spot dried blood specimens.Newborns with the concentrations higher than the critical threshold were recalled for serum creatine kinase measurements.Genetic testing was performed to confirm diagnosis in cases showing abnormalities.Results Among the screened 10 000 male newborns,two were confirmed to have DMD through genetic testing,resulting in a preliminary estimated incidence rate of 1/5 000 for male newborns in the Ningxia region.The critical threshold for creatine kinase isoenzyme concentration in newborns in this region was determined to be 468.57 ng/mL.Conclusions Screening for DMD in newborns is feasible in the Ningxia region.Early screening,diagnosis,and treatment of DMD can improve the quality of life for affected individuals and help families make informed decisions regarding further pregnancies.[Chinese Journal of Contemporary Pediatrics,2024,26(3):258-261]