BACKGROUND:Wogonin is a flavonoid extracted from the root of Scutellaria baicalensis.Previous studies have shown that baicalein has protective effects against cerebral ischemia-reperfusion injury,and can also reduce blood sugar and complications in diabetic mice,but its role and mechanism in diabetic cerebral infarction remain unclear. OBJECTIVE:To explore the effect of wogonin on nerve injury in rats with diabetic cerebral infarction and its mechanism. METHODS:Sprague-Dawley rats were randomly divided into six groups:control group,model group,low-dose wogonin group,medium-dose wogonin group,high-dose wogonin group,and high-dose wogonin+Ras homolog gene family member A(RhoA)activator group.Except for the control group,the other rats were established with diabetes and cerebral ischemia models using intraperitoneal injection of streptozotocin and middle cerebral artery occlusion.Low,medium-and high-dose wogonin groups were intragastrically given 10,20,40 mg/kg wogonin,respectively;high-dose wogonin+RhoA activator group was intragastrically given 40 mg/kg wogonin and intraperitoneally injected 10 mg/kg lysophosphatidic acid;control group and model group were given the same amount of normal saline once a day for 7 consecutive days.Rats in each group were evaluated for neurological deficits and their blood glucose levels were measured after the last dose.TTC staining was applied to detect the volume of cerebral infarction.Hematoxylin-eosin staining was applied to observe pathological changes in brain tissue.ELISA kit was applied to detect tumor necrosis factor-α,interleukin-6,malondialdehyde,and superoxide dismutase levels in brain tissue.Western blot was applied to detect the protein expression of RhoA and Rho-associated protein kinase(ROCK)2 in brain tissue. RESULTS AND CONCLUSION:Compared with the control group,the neuronal structure of rats in the model group was severely damaged,with cell necrosis and degeneration,the neurological deficit score,blood glucose level,and infarct volume were significantly elevated(P<0.05),the levels of tumor necrosis factor-α,interleukin-6,and malondialdehyde,and the protein expression of RhoA and ROCK2 in brain tissue were significantly increased(P<0.05),and the superoxide dismutase level was decreased(P<0.05).Compared with the model group,the low-,medium-,and high-dose wogonin groups showed improved neuronal damage,reduced cell degeneration and necrosis,a significant reduction in neurological deficit score,blood glucose level,infarct volume,and the levels of tumor necrosis factor-α,interleukin-6,and malondialdehyde,and the protein expression of RhoA and ROCK2 in brain tissue,and an increase in the superoxide dismutase level(P<0.05).Compared with the high-dose wogonin group,the high-dose wogonin+RhoA activator group significantly weakened the improvement in the above indexes of rats with diabetic cerebral infarction(P<0.05).To conclude,wogonin can improve the blood glucose level in rats with diabetic cerebral infarction,reduce cerebral infarction and nerve injury,and its mechanism may be related to the inhibition of RhoA/ROCK signaling pathway.

Objective:This study aims to explore the prevalence of hepatitis E virus (HEV) infection in patients and the screening value of serological indicators for HEV infection patients.Methods:Retrospective analysis was conducted on 97 440 cases of anti-HEV IgM and IgG simultaneously tested in two Beijing hospitals from January 1, 2018 to August 31, 2023. Among them, there were 61 005 males and 36 435 females, with an average age of 51.65±13.05 years old. According to the positivity of anti HEV specific antibodies, they were divided into anti-HEV IgM positive group (3 588 cases), anti-HEV IgG positive group (18 083 cases), and anti-HEV antibody negative group (78 892 cases). Results of HEV RNA, liver function, AFP, PIVKA-Ⅱ and PT were collected, and their basic clinical information were recorded. The prevalence of HEV infection in patients, as well as the relationship between the positivity of anti-HEV specific antibodies and the patient′s age group, HEV RNA, and clinical characteristics were analyzed.Results:Among 97 440 patients who tested anti-HEV IgM and IgG simultaneously, the positivity rate of anti-HEV IgM was 3.68% (3 588/97 440), and was 18.56% for anti-HEV IgG (18 083/97 440). The overall positivity rates of anti-HEV IgM in two Beijing hospitals from 2018 to 2023 were 2.51%, 2.53%, 3.02%, 4.59%, 5.72%, and 4.26% ( χ2=1 401.73, P<0.001), while the positivity rates of anti-HEV IgG were 12.56%, 12.32%, 12.85%, 22.65%, 27.42%, and 26.66% ( χ2=1 058.29, P<0.001). These rates showed a gradual increase until 2023 when a decline was observed. The positivity rates of anti-HEV IgM (2.28%, 3.60%, 4.47%) ( χ2=89.62, P<0.001) and IgG (4.71%, 17.86%, 25.94%) ( χ2=2 017.32, P<0.001) increased with age in patients who aged 1-30, >30-60, and over 60 years old. The age and ALB values of patients in the anti-HEV IgM positive group were lower than the IgG-positive group, while the proportion of males, TBIL, ALT, AFP and PT values were higher than the IgG-positive group, and the differences were statistically significance ( P<0.05). Furthermore, patients in both the anti-HEV IgM and IgG positive groups had higher age, male proportion, TBIL, ALT, AFP, PIVKA-Ⅱ, and PT values than the anti-HEV negative group. Additionally, both groups had lower ALB values than the anti-HEV negative group, all of which were statistically significant ( P<0.05). 2 162 HEV infected patients were grouped based on HEV RNA positivity. The proportion of anti-HEV IgM single positive, IgG single positive, IgM+IgG double positive, and antibody negative patients in the HEV RNA positive group were 5.42% (18/332), 3.62% (12/332), 90.36% (300/332), and 0.60% (2/332), respectively. Among them, the proportion of anti-HEV IgM+IgG double positive patients in the HEV RNA positive group was higher than that in the HEV RNA negative group ( χ2=302.87, P<0.001), while the proportion of anti-HEV IgG single positive ( χ2=174.36, P<0.001) and anti-HEV antibody negative patients ( χ2=59.28, P<0.001) were lower than that in the HEV RNA negative group, both of which were statistically significant ( P<0.001). In addition, the positive rates of HEV RNA in anti-HEV IgM positive, IgG positive, and antibody negative patients were 29.23% (318/1 088), 17.59% (312/1 774), and 0.65% (2/306), respectively. Conclusion:The HEV infection rate among patients declined in 2023. HEV infection is age-related, with older individuals being more susceptible. Abnormal liver function and jaundice were commonly observed during HEV infection. It is crucial to note that the absence of anti-HEV specific antibodies cannot rule out HEV infection; therefore, additional testing for HEV RNA and/or HEV Ag is necessary for accurate diagnosis.

Objective:To investigate the clinical efficacy and prognostic factors of 125I seeds implantation in the treatment of patients with advanced lung cancer after radiotherapy and chemotherapy. Methods:From January 2017 to December 2019, 44 patients (39 males, 5 females, age 41-84 years) with advanced lung cancer after radiotherapy and chemotherapy who received 125I seeds implantation in Hebei General Hospital were retrospectively analyzed. All patients were followed up for ≥12 months, and the clinical efficacies were observed. χ2 test was used to analyze the difference of effective rates between groups. The cut-off value of postoperative dose delivered to 90% gross tumor volume ( D90) was obtained by ROC curve analysis. Kaplan-Meier method was used to calculate the survival rate and log-rank test was used for univariate analysis. Cox proportional hazards model was used for multivariate analysis to find the influencing factors for clinical efficacy. Results:The total effective rate was 72.73%(32/44) after 6 months treatment. The cut-off value of D90 was 120 Gy with the AUC of 0.771. The short-term effective rate of D90≥120 Gy group was better than that of D90<120 Gy group (18/19 vs 56.00%(14/25); χ2=8.17, P=0.004). The 1-year survival rate was 77.27%(34/44). Univariate analysis showed that age ( χ2=3.99, P=0.046), preoperative Hb ( χ2=10.60, P=0.001), tumor maximum diameter ( χ2=11.50, P=0.001) and postoperative D90( χ2=5.81, P=0.016) could affect the survival of patients. Multivariate analysis showed that preoperative Hb (hazard ratio ( HR)=0.023, 95% CI: 0.001-0.882, P=0.043) and tumor maximum diameter ( HR=40.889, 95% CI: 1.458-1 146.586, P=0.029) were prognostic factors. Conclusions:125I seeds implantation shows a good effect in the treatment of lung cancer patients after the progress of radiotherapy and chemotherapy. The short-term effect of patients with D90≥120 Gy is better than that of patients with D90<120 Gy. Preoperative Hb and tumor maximum diameter are prognostic factors of survival after implantation.

Objective To explore the role of G protein pathway suppressor 2(GPS2)in regulating proliferation,migration and invasion in hepatocellular carcinoma cell line MHCC-97H.Methods The expression of GPS2 in hepatocellular carcinoma(HCC)cells were detected using quantitative PCR or Western blot;GPS2 was either over-expressed or knocked down in HCC cells using over-expression vectors or short hairpin RNAs(shRNAs)for GPS2,respectively.Clone formation assay,scratch assay and Transwell assay were used to detect the effects of GPS2 on proliferation,migration and invasion of HCC cells.Results In HCC cells,over-expression of GPS2 was found to inhibit the proliferation,migration and invasion of HCC cells MHCC-97H,while knockdown of GPS2 up-regulated proliferation,migration and invasion of MHCC-97H(P＜0.05).The over-expression of GPS2 in MHCC-97H cells was found to inhibit the expression of cell proliferation,migration and invasion-related factors such as EGFR,MMP1,MMP3 and MMP9,while knockdown of GPS2 upregulated the expression of these factors(P＜0.05).Conclusions GPS2 is a novel HCC regulatory factor that inhibits proliferation,migration and invasion of HCC cells.

Objective:To understand the etiological characteristics of 2 serotypes of Salmonella strains isolated from a foodborne disease outbreak. Methods:A total of 11 anal swabs of the cases, 13 suspected contaminated food and 10 environmental samples were collected from a foodborne disease outbreak occurred on September 8, 2022 in a school. The anal swabs were enriched with selenite brilliant green enrichment broth (SBG) and brain heart infusion broth (BHI) respectively. PCR detection and culture of common intestinal pathogens were carried out. The suspected food samples were tested according to national standards for food safety. Multiple suspected Salmonella colonies were obtained and selected for serotype determination and whole genome sequencing. Serotypes were determined based on the whole-genome sequence, and clustering analysis was performed based on core genome single nucleotide polymorphism (SNP). Results:The positive rates of Salmonella in anal swabs and suspected food samples were 9/11 and 5/13 respectively. Both Salmonella Uganda and Salmonella Idikan were isolated from 4 anal swabs and 4 suspected food samples. For the remaining samples, only Salmonella Uganda or Salmonella Idikan was isolated in each sample. The positive rate of Salmonella in 11 anal swabs of the cases after BHI enrichment for 12 h and 24 h were all 9/11 in real-time PCR, same to the culture results. Salmonella Uganda and Salmonella Idikan formed two independent and genetically distant lineages in the clustering tree based on core genome SNP, and 0-14 and 0-23 SNP were observed in Salmonella Uganda and Salmonella Idikan respectively. Conclusions:This foodborne disease outbreak was probably caused by Salmonella Uganda and Salmonella Idikan, which both exhibited strong genetic diversity. The PCR based pathogen screening strategy plus pathogen enrichment for cases' annal swabs can be used in the routine outbreak investigation.

Objective:To explore the criteria of general practice doctoral supervisors.Methods:The expert consultation questionnaire was formed by literature analysis. Experts in the field of general medicine from universities and tertiary hospitals in Shanghai were invited to participate in two rounds of Delphi consultation. The consultation content included the basic requirements and the importance evaluation of the selection criteria for general practice doctoral supervisors. Descriptive analysis and Analytic Hierarchy Process (AHP) were used to analyze the results of the study.Results:A total of 29 experts participated in the consultation, all with senior professional titles and doctoral degrees. The positive coefficient and expert authority coefficient of the two rounds of expert consultation were 1.0 and 0.925, respectively. The Kendall coordination coefficient of indicator importance evaluation were 0.436 and 0.397, respectively. The ethics, age, professional title, educational background and academic degree and diploma were considered to be included in the basic qualifications. The optimal standards for supervisor selection included teaching ability, scientific research ability, student training and team promotion ability that subdivided into 13 evaluation indexes.Conclusion:The basic qualifications and optimal standards for general practice doctoral supervisors have been preliminarily developed, which provides reference for selection of qualified general practice doctoral supervisors.

Objective:To apply the best evidence of evidence-based volume management in patients with chronic heart failure to clinical practice and evaluate its effect.Methods:From February 2018 to May 2019, according to the clinical evidence practice application mode of Joanna Briggs Institute (JBI), and the best evidence obtained in the previous study, we constructed audit indicators. And then perfomed clinical audits for the patients with chronic heart failure in the department of cardiology of Shandong Provincial Hospital affiliated to Shandong First Medical University. The obstacle factors were analyzed, and the action strategies were formulated. The cognition of the medical staff on the volume management, and the fasting body mass monitoring rate, the volume management target compliance rate, the time to dry body mass, average hospitalization day of the patients′, number of negative events related to volume management were compared before and after the application of the best evidence.Results:After the implementation of the reform, Indicator 8-14 and Indicator 20 of the 20 audit indicators implementation rate had been improved, and the difference was statistically significant ( χ 2 values were 6.668-97.000, P<0.05); the volume management target compliance rate increased from (34.24±30.33)% to (61.28±16.10)%, the difference was statistically significant ( t value was 30.21, P<0.001); the time to dry body mass decreased from (10.89±3.46) days to (5.48±1.58) days, the difference was statistically significant ( t value was 13.97, P<0.001); compared with the negative events related to the access control, the number of acute left heart failure cases decreased from 7 to 2 ( χ2 value was 4.194, P=0.041). Conclusion:Evidence-based volume management of patients with chronic heart failure can improve clinical nursing practice, shorten the time for patients to reach dry body mass, and reduce the average hospitalization day. Quality review still needs to continue to improve the quality of nursing.

Objective:To investigate the prognostic value of neuroelectromyography in peripheral facial paralysis and its correlation with House-Brackman classification.Methods:Seventy-eight patients with peripheral facial paralysis who received treatment in Yiwu Central Hospital, China between January 2016 and January 2019 were included in this study. All patients underwent neuroelectromyography. Bilateral nerve conduction velocity, latency, amplitude, and the needle electrode electrogram of orbicularis oris muscles, rbicularis oculi muscles and frontal muscles were analyzed and recorded. After 3 months of treatment, the correlation between prognosis and House-Brackman classification was analyzed.Results:Electromyography examination of 78 patients revealed among 68 patients presenting with prolonged latency, the latency on the affected side was significantly longer than that on the healthy side [(3.78 ± 0.33) ms vs. (2.89 ± 0.35) ms], t = 15.256, P < 0.001]. Among 73 patients presenting with decreased M amplitude, M amplitude on the affected side was significantly lower than that on the healthy side [(0.60 ± 0.27) mV vs. (1.83 ± 0.29) mV, t = 26.522, P < 0.001]. Among 78 patients, normal electromyography findings were observed in 2 patients and abnormal findings in 76 patients, with an abnormal rate of 97.44%. Among 78 patients, 46 patients presented with fibrillation potentials and positive sharp waves in the resting state, 40 patients presented with long duration and multiphase wave percentage of motor unit action potential in mild contraction, and 52 patients presented with abnormal recruitment potential in severe contraction. Three months of follow-up revealed that 23 out of 25 patients with mild peripheral facial paralysis had a complete recovery, with the cure rate of 92.00% (23/25), 28 out of 36 patients with moderate peripheral facial paralysis had a complete recovery, with the cure rate of 77.78% (28/36), 7 out of 10 patients with mild and moderate peripheral facial paralysis had a complete recovery, with the cure rate of 70.00% (7/10), and 3 out of 5 patients with severe peripheral facial paralysis had a complete recovery, with the cure rate of 60.00% (3/5). Conclusion:Neuroelectromyography can improve the accuracy in the identification of injury degree of peripheral facial paralysis and has a strong correlation with House-Brackman classification. Therefore, neuroelectromyography can provide a reference for diagnosis and treatment of peripheral facial paralysis.

Objective: To analyze the factors influencing the short-term efficacy of CT-guided ¹²⁵I seeds implantation in the treatment of recurrent and metastatic tumors in head and neck. Methods: A total of 73 patients (61 males, 12 females; age: (59.1±11.5) years) with head and neck tumors recurrence and metastasis treated by ¹²⁵I seeds implantation in Hebei General Hospital from January 2015 to April 2019 were retrospectively enrolled. The implanted seeds activity was 11.1-29.6 MBq, and the prescription dose was 80.0-145.0 Gy. CT examination was conducted 3 months after ¹²⁵I seeds implantation. According to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, short-term efficacy was classified as effective (complete remission (CR), partial remission (PR)) and ineffective (stable disease (SD), progressive disease (PD)). Univariate analysis of factors affecting short-term effect (gender, age, history of radiation therapy, Karnofsky performance status (KPS) scores, pathological type, the longest diameter of tumor, implantation patterns, seeds activity, immediate postoperative dose delivered to 90% gross tumor volume (D₉₀), and with adjuvant chemotherapy post-surgery or not) were conducted. Variables with P<0.2 were enrolled in logistic multivariate regression analysis. In addition, artificial neural network (ANN) was constructed with all influencing factors as independent variables and short-term efficacy as dependent variables. Finally, receiver operating characteristic (ROC) curve analysis was performed for the common influencing factors in logistic regression analysis and ANN analysis. Results: There were 34 with effective results and 39 with ineffective results. Logistic regression analysis indicated that the longest diameter of tumor, immediate postoperative D₉₀, with adjuvant chemotherapy post-surgery or not had significant impacts on the short-term efficacy (Wald values: 6.950, 4.804, 4.790, all P<0.05); According to results of ANN analysis, the top 5 in order of importance for short-term efficacy prediction were immediate postoperative D₉₀, the longest diameter of tumor, age, seeds activity and gender. ROC curve analysis indicated that the longest diameter of tumor and immediate postoperative D₉₀ were the best predictors for short-term efficacy, with the threshold of 5.25 cm and 110.05 Gy respectively, and the area under the curve (AUC) was 0.843 and 0.847 respectively (both P<0.001). Conclusions The short-term efficacy of ¹²⁵I seeds implantation in the recurrence and metastasis of head and neck tumors is mainly related to the longest diameter of tumor and immediate postoperative D₉₀. Patients with the longest diameter of tumor <5.25 cm and with D₉₀>110.05 Gy can achieve better efficacy.

Objective:To analyze the current situation and influencing factors of interruptions of clinical nurses during drug use, construct a feedforward control plan for nursing interruptions (NI) of nurses performing drug use, and discuss its application effects.Methods:From September 2018 to February 2019, we took the NI that occurred during drug use in four wards of the Cardiovascular Department of Shandong Provincial Hospital as the research object. Nurses involved in the interruptions were observed with the self-designed Observation Record Table and the structured observation method. We built an optimization team to establish a feedforward control plan for interruptions of nurses performing drug use. The plan was implemented in the same ward from March to December 2019, and nurses were observed after the plan was implemented. The research type of this study was a single-blind non-contemporaneous controlled clinical trial.Results:After 10 months of plan application, the frequency of interruptions of nurses performing drug use was reduced from 12.68 to 8.29 times per hour. Low priority events before intervention accounted for 68.34% (2 340/3 424) , and low priority events after intervention accounted for 59.17% (1 216/2 055) with a statistical difference (χ 2=47.390, P<0.001) . Negative outcome events before intervention accounted for 80.02% (2 740/3 424) ; negative outcome events after intervention accounted for 77.52% (1 593/2 055) , and the difference was statistically significant (χ 2=4.872, P=0.027) . The rate of medication hidden dangers caused by NI before intervention was 1.14% (39/3 424) ; after intervention, the rate of medication hidden dangers caused by NI was 0.58% (12/2 055) , and no medication error occurred after the second person filled in the gaps and observer reminded, the difference was statistically significant (χ 2=4.291, P=0.038) . Conclusions:The establishment and application of a feedforward control plan for NI can help to increase the priority of interruptions, avoid or reduce unnecessary interruptions during nursing medication, and improve the outcome of interruptions, which is of a positive significance for ensuring the safety of nursing medication.