To introduce and analyze guideline terminology related to clinical question formulation, evidence retrieval and appraisal, and recommendation development.

Objective:To develop and verify a nomogram to predict disease-free survival(DFS)and overall survival(OS)for patients undergoing cervical cancer surgery,which may provide reference for evaluating the prognosis of cervical cancer patients undergoing surgery.Methods:The clinical,pathological and follow-up data of patients who underwent radical operation for cervical cancer in Xijing Hospital,Air Force Medical University from March 2013 to October 2018 were analyzed retrospectively.Based on Cox regression analysis,Bayesian Informa-tion Criterion(BIC)backward stepwise selection method and R square screening variables,Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI)were used to compare the predictive efficiency of the model,and a nomogram with better predictive efficiency was selected.The consistency index(C-index)and the receiver operating characteristic curve(ROC)were used to test the efficiency of the nomogram.Results:A total of 950 patients with cervical cancer were enrolled in this study.The risk factors for constructing the DFS nomogram were FIGO stage(2018),parametrium invasion,invasion depth,and maximum tumor diameter.The C-index for DFS in the training cohort and the verification cohort were 0.754 and 0.720,respectively.The area under ROC of the training cohort for 1-,3-and 5-years was 0.74(95%CI 0.65-0.82),0.77(95%CI 0.71-0.83)and 0.79(95%CI0.74-0.85),and the areas under ROC of verification cohort 1-,3-and 5-years were 0.72(95%CI 0.58-0.87),0.75(95%CI 0.64-0.86)and 0.72(95%CI 0.61-0.84),respectively.The risk factors for con-structing the OS nomogram were FIGO stage(2018),histological type,LVSI,parametrium invasion,surgical mar-gin,and invasion depth.The C-index for OS in the training cohort and the verification cohort were 0.737 and 0.759,respectively.The area under ROC of the 3-and 5-year training cohort were 0.76(95%CI 0.69-0.83)and 0.78(95%CI 0.72-0.84),and the areas under ROC of verification cohort 3-and 5-years were 0.76(95%CI 0.65-0.87)and 0.79(95%CI 0.69-0.88),respectively.Conclusions:This study is based on real-world big data to construct nomogram of DFS for 1,3,and 5 years and OS for 3,and 5 years for cervical cancer,which have ideal predictive effects and help clinical physicians correctly evaluate the prognosis of cervical cancer surgery patients.It provides strong reference basis for diagnosis,treatment,and prognosis evaluation.

BACKGROUND:"Tendon off-position"is a disease name included in the International Classification of Diseases 11th Revision,and also a clinical indication of manipulation,acupuncture and other treatments.However,its specific mechanism is still unclear.It is urgent to establish an animal model that can reflect the clinical and pathological characteristics of"tendon off-position,"so as to further study the mechanism of effective clinical treatments. OBJECTIVE:To establish an animal model of"tendon off-position"in rats based on isometric contraction of skeletal muscles,and to explore the changes of skeletal muscle function and morphological phenotype after"tendon off-position." METHODS:Sixty rats were randomly divided into control group,static-loading group and extra loading group,with twenty rats in each group.Rats in the control group were kept normally without treatment.In the latter two groups,the rats were fixed by the self-made static-loading modeling device and a static-loading(the body mass of each rats was applied as the static-loading)was applied to cause sustained isometric contraction of the upper limb muscles.Then,animal models of"tendon off-position"were successfully established.In the extra loading group,50%of the body mass was added to the ankle joint after modeling.The skeletal muscle samples were harvested at 2 and 4 weeks after modeling.The changes of limb grip strength,wet mass of skeletal muscle,and serum levels of creatine kinase-muscle and lactate dehydrogenase A were measured,and the changes of skeletal muscle histomorphology and ultrastructure were observed. RESULTS AND CONCLUSION:At 2 weeks after modeling,the rats in the static-loading group and extra loading group showed significantly decreased grip strength and wet muscle mass,significantly increased serum levels of creatine kinase-muscle and lactate dehydrogenase A,and abnormal muscle fiber morphology and structure accompanied by a large number of deposited collagen fibers.Electron microscopy results showed that the structure of myofibrils was disordered,the Z-line was distorted,and the light and dark boundaries were blurred.At 4 weeks after modeling,the grip strength of the model rats was increased compared with that at 2 weeks,the serum creatine kinase-muscle and lactate dehydrogenase A levels were decreased,and the changes of muscle fiber morphology and ultrastructure were recovered to varying degrees.It is suggested that the rat skeletal muscle injury model based on continuous isometric contraction of skeletal muscle can well reflect the pathological characteristics of"tendon off-position"at 2 weeks,and can be used to study the mechanism of acupuncture and manipulation in the treatment of"tendon off-position."

OBJECTIVE To explore the improvement effect and mechanism of vitexin on asthmatic model mice based on Notch signaling pathway. METHODS Asthma model of mice was established by intraperitoneal injection of ovalbumin and aluminum hydroxide suspension and nebulization stimulation of ovalbumin， and randomly divided into model group， vitexin group （40 mg/kg）， Notch activator group （1 mg/kg Jagged1）， vitexin+Notch activator group （40 mg/kg vitexin+1 mg/kg Jagged1）， with 12 mice in each group. Another 12 mice were selected as the control group. Each group received intragastric/intraperitoneal injection of relevant medicine or normal saline， once a day， for consecutive 14 days. After the last medication， minute ventilation at rest （VE） and peak expiratory flow （PEF） were detected in mice； the pathological morphology of lung tissue and fibrosis degeneration were observed and determined. The proportion of T helper cell 17 （Th17） and T regulatory cell （Treg） in peripheral blood were detected， and the Th17/Treg ratio was calculated. The levels of serum inflammatory factors interleukin （IL）-18， IL-6， IL-17 and IL-10 were determined， and the expressions of Notch1， Delta-like ligand 4 （DLL4）， hairy and enhancer of split 1 （Hes1） in lung tissue were detected. RESULTS Compared with the control group， serious pathological injury and inflammatory cell infiltration occurred in the lung tissue of mice in the model group， while VE， PEF， the proportion of Treg cells in peripheral blood and serum level of IL-10 were significantly reduced （P＜0.05）； collagen volume fraction （CVF） in lung tissue， Th17 cells proportion and Th17/Treg ratio in peripheral blood， serum levels of IL-18， IL-6 and IL-17， and the protein expressions of Notch1， DLL4 and Hes1 in lung tissue were significantly increased （P＜0.05）. Compared with the model group， the pathological injury of lung tissue in vitexin group was significantly improved compared with model group， and the changing trend of the above indexes was reversed （P＜0.05）； Notch activator Jagged1 could significantly reverse the pharmacological effects of vitexin on asthmatic mice （P＜0.05）. CONCLUSIONS Vitexin can improve lung function， Th17/Treg immune imbalance and inflammatory response， and alleviate pathological injury and fibrosis of lung tissue in asthmatic mice by inhibiting the Notch signaling pathway.

Objective To discuss the clinical effect of biomimetic salivary gland induction technology in alleviating secondary xerostomia after endovascular intervention of isolated superior mesenteric artery dissection(ISMAD).Methods Using random number sampling method,a total of 80 patients with ISMAD,who received endovascular intervention at the Affiliated Nanjing Hospital of Nanjing Medical University of China between March 2020 and December 2022,were selected as the research subjects.For the patients of control group(n=40)the warm-water(25-35 ℃)cotton swab was adopted to moisten the lips from one hour to 48 hours after endovascular intervention,which was given once every 15 minutes within postoperative 1-2 hours,which was followed by once every 30 minutes within postoperative 3-48 hours.For the patients of study group(n=40)with the help of biomimetic salivary gland induction technology a continuous and controlled water flow at a rate of 15 mL/h was given from one hour to 48 hours after endovascular intervention to continuously keep the lips and mouth moist.The postoperative one-,12-,24-and 48-hour degrees of mouth dryness and oral comfort in both groups were analyzed.Results The postoperative one-,12-,24-,and 48-hour incidence of thirsty and the degrees of severity in the study group were significantly lower than those in the control group(all P＜0.01),and the degrees of oral comfort at postoperative different time points in the study group were remarkably better than those in the control group(all P＜0.01).Conclusion The use of biomimetic salivary gland induction technology in patients with ISMAD after receiving endovascular intervention therapy can significantly reduce the incidence and severity of thirsty and improve oral comfort.

Objective:To summarize the clinical manifestations, diagnosis, treatment and prognosis of acute flaccid myelitis (AFM) in children.Methods:Clinical characteristics of 4 AFM cases from Department of Neurology, Children′s Hospital Affiliated to Capital Institute of Pediatrics, from September 2018 to November 2022, were analyzed retrospectively.Results:The age of 4 children with AFM was 7 years, 4 years and 3 months, 7 years and 1 month, 6 years and 5 months, respectively. There were 2 boys and 2 girls. Prodromal infection status showed 3 children of respiratory tract infection and 1 child of digestive tract infection. The main manifestation was asymmetrical limb weakness after infection, and the affected limb range was from monoplegia to quadriplegia. Cranial nerve injury was involved in 1 child, no encephalopathy. Magnetic resonance imaging in the spinal cord of all 4 children showed long T1 and T2 signals, mainly involving gray matter. Cerebrospinal fluid cell-protein separation was observed in 2 children. Pathogen detected in 1 child pharyngeal swab was enterovirus D68. Antibody IgM to adenovirus was positive in the blood of 1 child. Antibody IgG against Echo and Coxsackie B virus were positive in the blood of another child. After glucocorticoid, human immunoglobulin or simple symptomatic treatment and at the same time under later rehabilitation training, muscle strength recovered to different degrees, but there were disabilities left in 3 children.Conclusions:AFM should be considered in children with acute and asymmetrical flaccid paralysis accompanied by abnormal magnetic resonance imaging signal in the central region of spinal cord, especially post-infection. The effective treatment is limited and the prognosis is poor.

OBJECTIVE To provide scientific basis for establishing the evaluation index system of professional and specialized drug inspectors in China. METHODS Through the method of literature research， group discussions and behavioral event interview， combined with the practice situation of drug inspection at home and abroad， in accordance with the requirements of Chinese laws and regulations and department rules， the evaluation indexes for drug inspectors were extracted and screened. In addition， the Delphi method was used to conduct correspondence with experts in relevant fields so as to determine the evaluation index system of drug inspectors. RESULTS & CONCLUSIONS Finally， 62 experts completed two rounds of anonymous online questionnaires， including 29 experts in the first round and 33 experts in the second round. The questionnaire recovery rates were 96.67% and 94.29% respectively， and the expert authority coefficients were 0.81 and 0.79， indicating a high level of authority among experts. After expert consultation， evaluation index system for professional and specialized drug inspectors had been constructed， including five first-level indexes （personal characteristics， professional knowledge， professional skills， professional behavior and professional ethics） and their corresponding 27 second-level indexes. The average score of the importance of second-level indexes was 4.224- 4.879， the full score ratio was 81.8%-100%， the coefficient of variation was 0.067-0.177， and Kendall’s W was 0.643 （P＜0.001）. It indicates that this evaluation index system is relatively reliable and is expected to become a management tool for promoting the construction of professional and specialized drug inspector team and ensuring the quality of drug inspection.

OBJECTIVE To optimize the molding process of Shuangye pipa granules based on the concept of quality by design （QbD） and analyze its physical fingerprint. METHODS The dry extract of Shuangye pipa granules was used as the main drug. The retention rate of total flavonoid， moisture absorption rate， dissolution rate， angle of repose and molding rate of the granules were selected as evaluation indexes. The single-factor test combined with the entropy weight method and Box-Behnken response surface design was used to optimize the molding process， and validation test was conducted. The physical fingerprints of 10 batches of Shuangye pipa granules prepared by the optimal process were comprehensively analyzed by eight secondary physical indexes （relative homogeneity， moisture， moisture absorption rate， Hausner ratio， angle of repose， bulk density， tap density and porosity）. RESULTS The optimal molding process of Shuangye pipa granules was as follows： soluble starch-maltodextrin-mannitol was 1∶1∶1 （m/m/m）， 95% ethanol was as wetting agent and the amount of it was 37%， the drug-assisted ratio was 1∶0.8 （m/m）， the drying temperature was 59 ℃， drying time was 28 min. The results of 3 validation tests showed that the average comprehensive score was 0.879 6， the RSD of which with prediction value （0.881 9 score） was 1.97%. The similarity between the physical fingerprints of 10 batches of Shuangye pipa granules and the control physical fingerprint was higher than 0.99. CONCLUSIONS The optimized molding process of Shuangye pipa granules is stable and feasible， and the physical property of Shuangye pipa granules is stable and controllable.

Objective:To explore the relationship among physical exercise, self-control, and mobile phone dependence in adolescents.Methods:The entire group of random sampling method was used to extract 882 students from five junior high schools in Nanchang city from September 2020 to March 2021.A longitudinal survey was conducted using the sports activity rating scale, self control scale, and adolescent mobile phone dependence scale on all participants for 2 times with an interval for 6 months.The questionnaire results in the first stage were marked as T1.The questionnaire results in the second stage were marked as T2.SPSS 26.0 statistical software was used to conduct reliability analysis, common method bias test and Pearson correlation analysis on each variable in sequence.AMOS 23.0 was used for cross-lag analysis to explore the relationship among physical exercise, self-control and mobile phone dependence.Results:The score of physical exercise of adolescents was (17.71±5.62), the score of self-control was (51.48±9.71), and the score of mobile phone dependencies was (56.67±12.93). Adolescent physical exercise, self-control, and mobile phone dependence were all related to stability across time.There were positive correlation between T1 physical exercise and T2 physical exercise ( r=0.489), T1 self-control and T2 self-control ( r=0.482), as well as T1 mobile phone dependencies and T2 mobile phone dependencies ( r=0.498)(all P<0.01). Cross-lag analysis showed that: adolescent physical exercise behavior could unidirectionally predict self-control( β=0.197, P<0.01)and mobile phone dependence( β=-0.224, P<0.01) after 6 months, and self-control could predict the mobile phone dependence( β=-0.560, P<0.01) of junior high school students after 6 months.The mediating effect results showed that self-control had a mediating effect between physical exercise and mobile phone dependence of junior high school students, there were gender differences.The mediating effect accounted for 22.22%(-0.018/-0.081). Conclusion:Physical exercise can indirectly reduce the mobile phone dependence of junior high school students by affecting self-control.

Objective To investigate the effects of edaravone dextran combined with argatroban on neurological function,blood rheology and posterior circulation hemodynamics in patients with acute cerebral infarction in the posterior circulation.Methods One hundred and fifty-six patients with acute cerebral infarction in the posterior circulation were collected and randomly divided into the conventional treatment group,edaravone dextranol treatment group(EDD treatment group)and edaravone dextranol combined with argatroban treatment group(combined treatment group),with 52 cases in each group.The general data of patients in the three groups were collected,and the changes of NIHSS score and Barthel index,blood rheology and posterior circulation hemodynamics were evaluated before and after treatment in the three groups.Results After treatment,NIHSS scores and Barthel index were significantly lower in all three groups than before treatment(all P＜0.01).The NIHSS score and Barthel index of the combined treatment group were significantly lower than those of the EDD treatment group and the conventional treatment group after treatment(all P＜0.05).The difference in total effective rate among the three groups was statistically significant(P＜0.05),and the total effective rate among in combined treatment group was significantly better than those in the EDD treatment group and the conventional treatment group(all P＜0.05).The platelet aggregation rate,erythrocyte pressure volume,whole blood specific viscosity and plasma specific viscosity in the three groups after treatment were significantly lower than those before treatment(all P＜0.01).After treatment,the platelet aggregation rate,erythrocyte pressure volume,whole blood specific viscosity and plasma specific viscosity of combined treatment group were lower than those of EDD treatment group and conventional treatment group(all P＜0.05).Peak systolic blood flow velocity(Vs)of basilar artery,vertebral artery and posterior cerebral artery in the three groups after treatment were significantly higher than those before treatment(all P＜0.01),and resistance index(RI)was significantly lower than that before treatment(all P＜0.01).The Vs of basilar,vertebral and posterior cerebral arteries in the combined treatment group were significantly higher than those in the conventional treatment group and the EDD treatment group(all P＜0.05),and the RI was significantly lower than that in the EDD treatment group and the conventional treatment group(all P＜0.05).There was no significant difference in the comparison of adverse reactions among the three groups(all P＞0.05).Conclusion Edaravone dextranol combined with argatroban can exert a good protective effect on neurological function in patients with acute cerebral infarction in the posterior circulation by improving blood rheology and posterior circulation hemodynamics.