OBJECTIVE To optimize the simmering technology of Rheum palmatum from Menghe Medical School and compare the difference of chemical components before and after processing. METHODS Using appearance score， the contents of gallic acid， 5-hydroxymethylfurfural （5-HMF）， sennoside A+sennoside B， combined anthraquinone and free anthraquinone as indexes， analytic hierarchy process （AHP）-entropy weight method was used to calculate the comprehensive score of evaluation indicators； the orthogonal experiment was designed to optimize the processing technology of simmering R. palmatum with fire temperature， simmering time， paper layer number and paper wrapping time as factors； validation test was conducted. The changes in the contents of five anthraquinones （aloe-emodin， rhein， emodin， chrysophanol， physcion）， five anthraquinone glycosides （barbaloin， rheinoside， rhubarb glycoside， emodin glycoside， and emodin methyl ether glycoside）， two sennosides （sennoside A， sennoside B）， gallic acid and 5-HMF were compared between simmered R. palmatum prepared by optimized technology and R. palmatum. RESULTS The optimal processing conditions of R. palmatum was as follows: each 80 g R. palmatum was wrapped with a layer of wet paper for 0.5 h， simmered on high heat for 20 min and then simmered at 140 ℃， the total simmering time was 2.5 h. The average comprehensive score of 3 validation tests was 94.10 （RSD＜1.0%）. After simmering， the contents of five anthraquinones and two sennosides were decreased significantly， while those of 5 free anthraquinones and gallic acid were increased to different extents； a new component 5-HMF was formed. CONCLUSIONS This study successfully optimizes the simmering technology of R. palmatum. There is a significant difference in the chemical components before and after processing， which can explain that simmering technology slows down the relase of R. palmatum and beneficiate it.

Traditional Chinese medicine （TCM） therapy has unique clinical advantages in the treatment of atrial fibrillation， mainly reflected in five aspects， improving quality of life， enabling early diagnosis and treatment， promoting cardiac rehabilitation， making up for the limitations of Western medicine， and improving the success rate of catheter ablation. However， there is insufficient evidence in current clinical research. Based on the current status of TCM research in the treatment of atrial fibrillation， it is suggested that future studies should focus on standardized research on syndrome differentiation and classification. This can be achieved through clinical epidemiological surveys， expert consensus， and other methods to establish a unified syndrome differentiation and classification standard for atrial fibrillation. Clinical efficacy evaluation indicators should be standardized， and core outcome measures for clinical research on TCM treatment of atrial fibrillation should be developed through systematic reviews， patient interviews， and other methods. Additionally， clinical research design， implementation， and data management should be improved. By leveraging modern information technologies such as artificial intelligence， the scientific and standardized nature of TCM intervention research on atrial fibrillation can be enhanced， ultimately improving the quality of research.

Objective To establish a method for rapid detection of tramadol in urine by liquid-liquid extraction（LLE）-surface-enhanced Raman spectroscopy （SERS）. Methods Tramadol was extracted from urine with chloroform∶isopropyl alcohol （9∶1） extractant and detected in urine samples by enhanced Raman spectroscopy （wavelength 785 nm）. Results The quantitative curve of tramadol was Y=204.35 X−465.62, r=0.9952, and the linear range was 1-100 μg/ml. The detection limit of tramadol by this method （S/N=3） was 0.53 μg/ml. The sensitivity of SERS was higher than that of conventional methods, and it had reasonable reproducibility. Conclusion This method is simple, efficient and economical, and can be used for qualitative and quantitative analysis of tramadol personalized medicine.

Objective To explore EEG characteristics and the therapeutic effect in children with electrical status epilepticus during slow sleep(ESES).Methods The eligible ESES cases in our center from 2014 to 2020 were included.The age at diagnosis of ESES,the duration of ESES,spike wave index(SWI)during wakefulness and the distribution of spike wave during the period of ESES,age at seizure onset,the clinical syndromes and the outcomes after treatment were analyzed.The ESES cases were divided into 4 groups according to the distribution of spike wave:focal ESES,unilateral ESES,bilateral asymmetric ESES,multiple foci ESES.The SWI during the awake stage were divided into 3 groups based on the different rates:≤20%,21%～49%,≥50%.The therapeutic outcomes were classified into three groups:satisfactory response,seizure control and ineffective.Results 50 cases were included,with 32 males and 18 females.The average onset age of ESES was 6 years and 7 months,and the average duration of ESES was 28 months.A significant correlation between the distribution of ESES and the thera-peutic effects was found,bilateral asymmetric ESES had a good therapeutic effects,while multiple foci ESES showed a poor therapeutic effects.The duration of ESES was significantly correlated with therapeutic effects,and the efficacy was worse when the duration was longer than 1 year.A significant relationship between the SWI during wakefulness of ESES and the therapeutic effects was detected,the patient with SWI≤20%during wakefulness had a good therapeutic effect.There was a negative correlation between the onset age of ESES and the duration of ESES and SWI index during wakefulness.There was a positive correlation between the duration of ESES and SWI index during wakefulness.Conclusion Our results suggest that onset age,distribution,duration and SWI during wake-fulness of ESES were correlated with therapeutic outcomes,The patient with SWI≤20%during wakefulness had a good therapeutic effect and have unfavorable outcomes with ESES last more than 1 year.The earlier onset of ESES,the longer duration of ESES and higher SWI during wakefulness will be showed..

Objective To construct,implement and evaluate the effectiveness of the virtual simulation technology-based prenatal health education course.Methods The curriculum included 4 parts:"warm delivery room and easy delivery","medicated analgesic delivery","non-medicated analgesic delivery"and"early maternal and infant health care".From May to September 2022,100 primiparas in an obstetrics and gynecology hospital in Zhejiang Province were investigated by convenient sampling method.Random number table method was used to divide the participants into an experimental group and a control group,with 50 participants per group.The control group received conventional health education,while the experimental group received an augmented virtual reality technology-based prenatal health education course during the late stages of pregnancy on this basis.We conducted a post-intervention comparative analysis of antenatal anxiety levels,fear of childbirth,and birth outcomes between the 2 groups.Furthermore,a post-intervention satisfaction survey was administered to the experimental group.Results After intervention,the antenatal anxiety of the experimental group was lower than that of the control group(x2=4.943,P=0.026),and the decrease in fear of childbirth scores was higher than that of the control group(t=3.200,P=0.002).The experimental group was highly satisfied with all of the 4 dimensions of the course,and the overall evaluation was(31.8±3.23)points.However,there were no significant differences in vaginal delivery rate,postpartum bleeding volume,postpartum hemorrhage incidence,perineal injury degree and duration of each labor stage between the 2 groups(P＞0.05).Conclusion The virtual reality technology-based prenatal health education course was effective in improving the antenatal anxiety and fear of childbirth of primipara,and the use satisfaction is high.

Objective To investigate the ocular biological parameters of children with idiopathic short stature(ISS)and compare them with those of children with growth hormone deficiency(GHD)and normal children,and to explore the characteristics of ocular biological parameters in this group,so as to provide a reference for the screening of visual acuity and the safety of growth hormone therapy in children with ISS.Methods A total of 15 children aged 5-14 years old with ISS were selected as the observation group,32 children with GHD were selected as the control group,and 47 children of normal height who underwent routine visual acuity screening were selected as normal controls.The ocular biological parameters of children with ISS were studied.The differences of vision-re-lated parameters between the above three groups were compared.The influencing factors affecting the visual devel-opment of children with ISS were analyzed.Results The axial ratio of ISS was significantly higher than that of the GHD group and normal children,and the intraocular pressure of the ISS group was significantly higher than that of the GHD group and normal children.There was no significant difference in axial length between the ISS group and the GHD group,as well as normal children(P＞0.05),but the axial length of the GHD group was significantly shorter than that of normal children.The corneal curvature of ISS was significantly greater than that of normal chil-dren.The axial rate ratio of the ISS group was positively correlated with the peak value and corneal curvature of growth hormone provocation test(β=1.052,P＜0.05;β=0.004,P＜0.05).Conclusion Children with ISS may have high intraocular pressure and high risk of myopia.Higher peak results of growth hormone provocation test and large corneal curvature may be the risk factors for myopia.

Objective:To analyze the mutation characteristics of rpoB gene in rifampicin-resistant Brucella strains. Methods:DNA of 4 rifampicin-resistant Brucella strains (JSY-26, G-9, WSY-13 and AW-3) isolated from Xinjiang Uygur Autonomous Region was selected, rifampicin rpoB gene was amplified by PCR and its nucleotide sequence was sequenced. The rpoB gene sequences of rifampicin-resistant Brucella standard strain (RB51) and sensitive strain (ALT-8) were used as reference, the mutation sites and types of the rpoB gene inside and outside the rifampicin resistance determination region (RRDR) of the 4 rifampicin-resistant Brucella strains were analyzed by Mega 7.0 software. Results:Through sequence alignment, both JSY-26 and WSY-13 strains underwent a single base point mutation at the RRDR 1 576 bp of the rpoB gene, with the base changing from guanine (G) to adenine (A). The G-9 strain underwent a single base point mutation at the RRDR 1 606 bp of the rpoB gene, with the base changing from cytosine (C) to A. The AW-3 strain showed 5 mutations of 3 types outside rpoB gene RRDR at 2 536, 2 537, 2 626, 2 636 and 2 654 bp, namely 3 insertion mutations [thymine (T) insertion once and C insertion twice], 1 deletion mutation (C deletion), and 1 single base point mutation (from G to C mutation).Conclusion:The RRDR mutations in the rpoB gene of the rifampicin-resistant Brucella strains are mainly characterized by single base point mutations, while multiple insertion and deletion mutations occur outside the RRDR.

Objective: To understand towards core competence of integrated medicine-education health teachers of graduates with undergraduate major of health education in China, so as to provide evidence for improving the quality of teaching workforce. Methods: From January to May 2023, a questionnaire survey was conducted on 92 primary and secondary school health teachers who graduated from Sanda University. All the participants reported the achievement of core competence after graduation, the performance of core competence at present and the importance of competencies. Group comparisons were conducted by using t-test or analysis of variance, while open ended questions were analyzed by using word cloud analysis. Results: In the nine dimensions of core competency, the top three dimensions among scores of achievement and performance were general quality as a teacher, emergency response to accidents(4.52±0.59, 4.38±0.61, 4.32±0.70), and prevention and control of public health events in schools ( 4.58 ±0.55, 4.49±0.62, 4.50±0.61). Compared with the achievement after graduation, the mean score of the current performance of core competence has increased in all dimensions except for basic health education literacy ( t=2.28-4.69, P <0.05). Among them, the rank of Basic Literacy of Health Education decreased significantly compared to graduation time (ranking down from 5th to 8th), and School Health Management and Improvement increased significantly (ranking up from 8th to 5th). There were no statistically significant differences in the achievement and the current performance scores of the core competence among graduates with different graduation years ( F=0.56-1.45, 0.73-1.23, P >0.05). According to the respondents, the most important competencies were associated with emergency response to accidents, prevention and control of infectious diseases, identification and management of common disease symptoms, and teachers moral cultivation. Conclusions The development of core competencies for healthcare teachers in integrated medical and educational schools is not yet balanced, the core competency performance of graduates with major of health education varied significantly by graduation time. Medical related abilities and professional ethics are considered the most important core competencies for graduates.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Background::Heterotaxy (HTX) is a thoracoabdominal organ anomaly syndrome and commonly accompanied by congenital heart disease (CHD). The aim of this study was to analyze rare copy number variations (CNVs) in a HTX/CHD cohort and to examine the potential mechanisms contributing to HTX/CHD.Methods::Chromosome microarray analysis was used to identify rare CNVs in a cohort of 120 unrelated HTX/CHD patients, and available samples from parents were used to confirm the inheritance pattern. Potential candidate genes in CNVs region were prioritized via the DECIPHER database, and PNPLA4 was identified as the leading candidate gene. To validate, we generated PNPLA4-overexpressing human induced pluripotent stem cell lines as well as pnpla4-overexpressing zebrafish model, followed by a series of transcriptomic, biochemical and cellular analyses. Results::Seventeen rare CNVs were identified in 15 of the 120 HTX/CHD patients (12.5%). Xp22.31 duplication was one of the inherited CNVs identified in this HTX/CHD cohort, and PNPLA4 in the Xp22.31 was a candidate gene associated with HTX/CHD. PNPLA4 is expressed in the lateral plate mesoderm, which is known to be critical for left/right embryonic patterning as well as cardiomyocyte differentiation, and in the neural crest cell lineage. Through a series of in vivo and in vitro analyses at the molecular and cellular levels, we revealed that the biological function of PNPLA4 is importantly involved in the primary cilia formation and function via its regulation of energy metabolism and mitochondria-mediated ATP production. Conclusions::Our findings demonstrated a significant association between CNVs and HTX/CHD. Our data strongly suggested that an increased genetic dose of PNPLA4 due to Xp22.31 duplication is a disease-causing risk factor for HTX/CHD.