Osteoarthritis （OA） is a common degenerative joint disease with a rising incidence rate year by year. Treatment often relies on analgesics and non-steroidal anti-inflammatory drugs （NSAIDs）， which can lead to gastrointestinal damage with long-term use and the recurrence of symptoms. Chinese medicine has a long history of preventing and treating OA， with widespread application and fewer side effects. It offers unique advantages such as a broad treatment scope， multiple targets， and pathways. The effective components of Chinese medicine can reduce the content of reactive oxygen species （ROS）， relieve oxidative stress （OS） damage， and increase the antioxidant capacity of the body by interfering with the expression of biomarkers of OS response such as malondialdehyde （MDA） and superoxide dismutase （SOD）. Through the modulation of signaling pathways such as nuclear factor E₂-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1）， phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）， nuclear factor kappa B （NF-κB）， c-Jun N-terminal kinase （JNK）， NOD-like receptor protein 3 （NLRP3）， and osteoprotegerin （OPG）， they downregulated the expression of inflammatory factors such as interleukin-6 （IL-6）， interleukin-1β （IL-1β）， and tumor necrosis factor-α （TNF-α）， thereby effectively relieving local joint inflammation， protecting chondrocytes and bone tissue， inhibiting chondrocyte apoptosis， and further alleviating the progression of OA. Currently， there are still certain limitations in the medical research status and development trends of OA， necessitating the continued advancement of traditional Chinese medicine. This paper reviewed the literature on the regulation of OS response by effective components of Chinese medicine for the prevention and treatment of OA， providing new directions and ideas for future research.

Objective:To optimize the alcohol precipitation process of Quhan Zhufeng Granules.Methods:Taking the volume fraction of ethanol, the relative density of the concentrated solution and the standing time as the investigation factors, the Z value of the total evaluation of gentiopicrin content, oleanolic acid content and dry paste yield of gentiana macrophylla as the evaluation indexes, the star-point design-response surface method was used to optimize the alcohol precipitation process.Results:The optimal the alcohol precipitation process of Quhan Zhufeng Granules: concentration relative density 1.08 g/ml (90-95 ℃), alcohol precipitation at the end of volume fraction of 62% ethanol, standing for 16 h.Conclusion:The alcohol precipitation process using overall desirability and central composite design is stable and feasible, and has good predictability, which can provide experimental basis for further scale production.

To analyze the trends in disease burden and risk factors of depression among the elderly population in China from 1990 to 2021, and to provide a theoretical basis for the prevention, treatment, and policy-making of geriatric depression in China.

Objective:To explore the current status and influencing factors of fertility intention to have a third child among childbearing age women in Heilongjiang Province under three-child policy.Methods:From January to April 2023, convenience sampling was used to select 10 600 women of childbearing age from ten districts and counties in five cities in Heilongjiang Province (Jiamusi, Qiqihar, Harbin, Heihe, Suihua) as research subjects. The Fertility Intention to Have a Third Child Questionnaire among Childbearing Age Women in Heilongjiang Province was used to investigate women of childbearing age. Multi-class Logistic regression was used to explore the influencing factors of fertility intention of childbearing age women to have a third child.Results:A total of 10 600 questionnaires were distributed, and 9 554 valid questionnaires were collected, with a valid response rate of 90.13% (9 554/10 600). Among 9 554 women of childbearing age, 2 248 had the intention to have a third child, 5 036 had no intention, and 2 270 were uncertain. Multi-class Logistic regression analysis showed that age, education level, per capita monthly income of the family, occupation, fertility status, pregnancy complications, economic pressure to have a third child, parents' attitudes towards having a third child, and satisfaction with childcare services were the influencing factors of the fertility intention of childbearing age women in Heilongjiang Province to have a third child ( P<0.05) . Conclusions:Under the three-child policy, women of childbearing age in Heilongjiang Province have a low intention to have a third child. Relevant departments should formulate policies based on the influencing factors.

The global COVID-19 coronavirus pandemic has infected over 109 million people, leading to over 2 million deaths up to date and still lacking of effective drugs for patient treatment. Here, we screened about 1.8 million small molecules against the main protease (M^pro) and papain like protease (PL^pro), two major proteases in severe acute respiratory syndrome-coronavirus 2 genome, and identified 1851M^pro inhibitors and 205 PL^pro inhibitors with low nmol/l activity of the best hits. Among these inhibitors, eight small molecules showed dual inhibition effects on both M^pro and PL^pro, exhibiting potential as better candidates for COVID-19 treatment. The best inhibitors of each protease were tested in antiviral assay, with over 40% of M^pro inhibitors and over 20% of PL^pro inhibitors showing high potency in viral inhibition with low cytotoxicity. The X-ray crystal structure of SARS-CoV-2 M^pro in complex with its potent inhibitor 4a was determined at 1.8 Å resolution. Together with docking assays, our results provide a comprehensive resource for future research on anti-SARS-CoV-2 drug development.
Humans ; Antiviral Agents/chemistry* ; COVID-19 ; COVID-19 Drug Treatment ; High-Throughput Screening Assays ; Molecular Docking Simulation ; Protease Inhibitors/chemistry* ; SARS-CoV-2/enzymology* ; Viral Nonstructural Proteins

Objective:To study the complications and prognosis of extremely premature infants(EPIs) with gestational age (GA) <28 w.Methods:From January 2016 to December 2020, EPIs with GA <28 w admitted to NICU of our hospital were retrospectively studied. Clinical data of the infants and their mothers during pregnancy were reviewed. According to the prognosis, the infants were assigned into the survival group, the death group and the withdrawal group. According to GA, the infants were assigned into <26 w goup, 26~26 +6 w group, ≥27 w group. According to birth weight (BW), the infants were assigned in to ≤750 g group, 750~999 g group and ≥1 000 g group. SPSS 26.0 was used for data analysis. Results:A total of 265 EPIs were included, 122 (46.0%) in the survival group, 47 (17.7%) in the death group and 96 (36.2%) in the withdrawal group. GA and BW of the survival group were significantly higher than the death group and the withdrawal group ( P<0.05). The incidences of tracheal intubation (92.2%) and pulmonary hemorrhage (42.2%) in the death group were the highest among the three groups. The survival group had the highest application of prenatal glucocorticoids (80.3%) and pulmonary surfactants (99.2%) ( P<0.05). In the survival group, the top 3 common complications were bronchopulmonary dysplasia (BPD) (68.0%), pulmonary infections (65.6%) and neonatal sepsis (34.4%). The survival rate increased with GA and BW. Conclusions:The survival rate of EPIs is closely correlated with GA and BW. EPIs with pulmonary hemorrhage and tracheal intubation have poor prognosis. Prenatal glucocorticoids and pulmonary surfactant may improve clinical outcome. BPD and pulmonary infections are common complications of surviving EPIs.

Objective:To investigate the rationality and surgical errors in countermeasures against difficult removal of screws so as to provide reference for standardization of technical procedures.Methods:A retrospective study was conducted to analyze the data of 99 patients who had encountered difficult removal of screws in operative removal of internal fixation at Department of Orthopaedics, Wuxi NO.9 People's Hospital Affiliated to Suzhou University from January 2018 to May 2022. There were 62 males and 37 females with an average age of 38.8±14.7 years. Their internal fixation time ranged from 7 months to 11 years. The irrationality was defined as insufficient preoperative preparation or a countermeasure that failed to follow the surgical indications or scientific principles of minimal injury or priority of simplicity. A surgical error was defined as unnecessary injury, failed removal or complications related to operation. Cases of irrationality and surgical errors were analyzed to find associations between them.Results:The operative removal was successful in 92 cases and failed in 7 cases. Of the patients who experienced difficult removal of screws, irrationality was found in 26.3% (26/99) and a surgical error or errors occurred in 28.3% (28/99). In the patients with countermeasure irrationality, the incidence of surgical errors was 53.9% (14/26) while in those without countermeasure irrationality, the incidence of surgical errors was 19.2% (14/73), showing a statistically significant difference ( χ2=11.360, P<0.001). In the patients with surgical errors, the incidence of countermeasure irrationality was 64.3% (18/28) while in the patients without surgical errors, the incidence of countermeasure irrationality was and 11.3% (8/71), showing a statistically significant difference ( χ2=29.148, P<0.001). In the patients with failed removal, the rate of countermeasure irrationality was 85.71% (6/7) while in those with successful removal, the rate of countermeasure irrationality was 21.7% (20/92), showing a statistically significant difference ( χ2=13.748, P<0.001). Conclusions:Close relationships exist between countermeasure irrationality, surgical errors and failed removal. The higher proportion of countermeasure irrationality, the higher possibility of surgical errors. Therefore, following the rationality principle may avoid or reduce surgical errors in difficult removal of screws.

Objective:To construct a practical teaching system for the undergraduate midwifery majors based on job competence.Methods:Based on the core competencies of the midwife position proposed by the International Confederation of Midwives, and using the Competency Outcomes and Performance Assessment as the construction tool, literature research, group interviews, and the Delphi expert consultation were used to conduct two rounds of consultation with 18 experts to construct a practical teaching system for undergraduate midwifery majors based on job competence.Results:In the two rounds of expert consultation, the effective recovery rates of the questionnaire were 100% (20/20), 94.44% (17/18), the expert authority coefficients were 0.70 to 0.95, 0.75 to 0.95, the Kendall's W were 0.49 and 0.65 ( P<0.05), and the coefficients of variation of indicators at all levels were 0.05 to 0.23, 0.05 to 0.18. The final practical teaching system for undergraduate midwifery majors included four practical teaching sections, including pregnancy healthcare, childbirth healthcare, postpartum healthcare, and comprehensive professional competence and literacy, as well as 13 core skills. Conclusions:The practical teaching system for undergraduate midwifery majors based on job competence is scientific, practical, and operable, which can provide reference for the development and implementation of practical teaching in undergraduate midwifery majors.

Objective:To explore the effects of the Otago Exercise Program (OEP) in aged patients diagnosed with sarcopenia.Methods:Totally 80 sarcopenic patients admitted to the Department of Geriatric Diseases at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between January 2022 and January 2023 were selected by convenience sampling. Using a random number table, patients were allocated into control and intervention groups, each containing 40 individuals. The control group underwent routine follow-ups, while the intervention group received a 12-week OEP in addition to the regular follow-up. Measures were taken before and after the intervention for muscle strength (grip strength, 5-times sit-to-stand test time) , muscle mass (skeletal muscle mass index) , physical function (6 m walking speed, Short Physical Performance Battery, SPBB) , and quality of life (Sarcopenia Quality of Life, SarQoL) .Results:Post-intervention, the 5-times sit-to-stand test time was lower in the intervention group compared to the control group ( P<0.05) . Moreover, the 6 m walking speed, SPBB scores, and SarQoL scores were higher in the intervention group ( P<0.05) . However, no significant statistical differences were found between the two groups regarding grip strength and skeletal muscle mass index ( P>0.05) . Conclusions:The OEP can enhance lower limb muscle strength, improve physical function, and elevate the quality of life in aged sarcopenic patients. This provides medical professionals with a reference for designing exercise plans for these individuals.

Objective:To evaluate the practical effects of perioperative diet optimization in pediatric fracture surgery, and explore the clinical efficacy and application value of circular management combined with diet optimization.Methods:Totally 76 children with selective fracture surgery were selected from May 2020 to October 2020 admitted to Wuxi 9th People′s Hospital Affiliated to Soochow University. They were divided into experimental group (38 cases) and control group (38 cases) by random number table method. Experimental group conducted circular management combined with diet optimization for nursing, while control group used only simple diet optimization management. The time and the amount of fasting before and after operation of two groups were recorded, and the compliances of two groups were evaluated according to the total amount of intake. The incidence of subjective adverse feelings, including hunger, thirst, dizziness, fatigue and nausea, were observed. And the satisfactions of patients with nursing management were also evaluated.Results:The preoperative fasting time, preoperative drinking prohibition time, postoperative diet recovery time were (8.25 ± 1.56), (2.76 ± 0.69), (1.17 ± 0.58) h in experimental group, and (9.79 ± 2.51), (3.47 ± 1.18), (1.50 ± 0.80) h in control group, and the differences were statistically significant ( t=-3.21, -3.17, -2.07, all P<0.05). The compliance rates to nursing and fasting before and after operation in control group were 57.9% (22/38), 65.8% (25/38), 76.3% (29/38) and 81.6% (31/38) respectively, which were significantly lower than all 100.0% (38/38) in experimental group ( P<0.05). During preoperative period (hunger), postoperative period when allowing intake (hunger, thirst, dizziness, feebleness) and 6 hours after intake (thirst, feebleness), the incidences of subjective adverse feelings in experimental group were statistically lower than those in control group ( Z values were -3.17- -1.97, all P<0.05). The satisfaction to dietary nursing management in experimental group was (93.82 ± 4.57) scores, which remained higher than (87.24 ± 6.65) scores in control group, and the difference was statistically significant ( t=5.03, P<0.01). Conclusions:Single perioperative diet optimization can easily be affected by the unstable clinical compliance of traumatic children, resulting in a low implementation rate. The combination of circular management and diet optimization can improve the intervention implementation and treatment compliance, shorten the time of diet prohibition, accelerate the postoperative recovery, and reduce the occurrence of perioperative adverse reactions.