As a new type of immunosuppressant，iguratimod can mediate the anti-inflammatory signaling pathway by inhibiting the proliferation of inflammatory cells and reducing the release of inflammatory cytokines， and play the role of anti-inflammatory. It can affect the proliferation of immune cells and the expression of immune factors，reduce the production and deposition of immune complexes in the body，and play the role of immune regulation. It can regulate bone metabolism by mediating signaling pathways such as Wnt/β-catenin，Toll-like receptor 4/nuclear factor-κB and osteoprotegerin/nuclear factor-κB receptor activating factor ligand， and play a role in bone protection. It can inhibit pulmonary fibrosis by inhibiting the expression of transforming growth factor β1/ Smad2/3 signaling pathway，tumor necrosis factor-α，interleukin-1，interleukin-6，matrix metalloproteinase-9 and other inflammatory cytokines in lung tissue，and inhibiting the expression of collagen and fibronectin. Its efficacy and safety have been confirmed in the clinical application of rheumatoid arthritis and primary Sjogren syndrome and included in the diagnosis and treatment of the disease. It has also shown good efficacy in the clinical application of other connective tissue diseases such as systemic lupus erythematosus and ankylosing spondylitis，and no obvious safety risks have been found.

Background and aims:Promoting gastrointestinal function recovery is one of the key aspects of enhanced recovery after surgery(ERAS)for colorectal cancer(CRC).Many ancient Chinese medical texts suggest that acupuncture at four acupoints—Zusanli,Shangjuxu,Sanyinjiao,and Neiguan—helps promote gastrointestinal peristalsis.However,there is currently no systematic study on multi-point acupuncture to promote postoperative gastrointestinal function recovery in CRC patients.Therefore,this study was conducted to evaluate the clinical efficacy of multi-point acupuncture in promoting gastrointestinal function recovery in CRC patients through a prospective study to provide new options for implementing ERAS in CRC patients in clinical practice. Methods:Using a prospective,randomized,controlled design,a total of 100 eligible patients who underwent laparoscopic CRC radical surgery at the Department of Gastrointestinal Surgery,Third Xiangya Hospital of Central South University,between January 2021 and February 2022,were randomly divided into an observation group and a control group,with 50 patients in each group.Both groups underwent the same ERAS protocols and radical surgery during the perioperative period.The observation group received acupuncture treatment from the day of surgery to the third postoperative day,once per day,while the control group did not receive acupuncture.Primary outcomes included the time to bowel sound recovery,time to first flatus,and time to first defecation.Secondary outcomes included abdominal pain scores,incidence of bloating,nausea,vomiting,white blood cell count,neutrophil percentage,C-reactive protein,hemoglobin,serum albumin,blood potassium levels,postoperative hospital stay,and incidence of postoperative complications. Results:A total of 96 patients completed the study,with 48 in each group.There were no statistically significant differences in baseline characteristics such as age,gender,or surgery time between the two groups(all P＞0.05).Compared with the control group,the observation group had a significantly shorter time for bowel sound recovery,first flatus,first defecation,and postoperative hospital stay(all P＜0.05).Additionally,the observation group showed reduced abdominal pain scores on postoperative day(POD)2 and 3,a lower incidence of bloating on POD 1 and 2,and a reduced incidence of nausea and vomiting on POD 3(all P＜0.05).There were no statistically significant differences in the remaining comparisons between the two groups(all P＞0.05). Conclusion:Multi-point acupuncture treatment can promote the recovery of gastrointestinal function in patients undergoing minimally invasive CRC surgery without increasing postoperative complications,and it is recommended for integration into routine ERAS protocols.

Objective This paper aims to investigate and analyze the baseline conformity rate of bacterial culture exami-nation records in a tertiary specialized hospital.By doing this,this paper seeks to understand the current situation of medical re-cord writing of bacterial culture examination and explore the improvement path and relevant measures for enhancing the conformity rate of bacterial culture examination records.Methods According to the requirements of"Quality Control Index of Medical Re-cord Management(2021 Edition)",a retrospective analysis was conducted on 6 317 medical records that underwent bacterial culture examination in 2022.Results The execution rate of medical orders was 100.00％,the completeness rate of the report sheet was 100.00％,the record rate of medical records was 81.05％,the analysis rate of results was 33.07％,and the conformi-ty rate of bacterial culture examination records was 33.07％.Conclusion It is imperative to enhance the conformity rate of bac-terial culture examination records and improve the quality of medical records in terms of content.

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.

Objective To systematically analyze influencing factors of migration stress of patients'families transferred out of intensive care unit(ICU)in China,and provide evidence-based guidance for alleviating migration stress level of families of transferred patients.Methods Computer searches were conducted on China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,VIP,China Biomedical Literature Database,Web of Science,PubMed,the Cochrane Library and Embase for observational studies such as cohort studies,case-control studies and cross-sectional studies on factors influencing migration stress among family members of ICU patients.Search deadline was from database establishment to October 2023.Literature screening,quality assessment and data extraction were conducted independently by two researchers in accordance with the inclusion and exclusion criteria.RevMan5.4 software was used to conduct a Meta-analysis of the data results.Results Fifteen studies were finally included,with a total sample size of 2558 and 12 influencing factors were extracted.Fifteen articles were divided into positive scoring group(higher scores,higher levels of migration stress,nine articles)and negative scoring group(higher scores,lower levels of migration stress,six articles)based on instruments used to measure outcome indicators.When analyzing each group,only factors mentioned in the group more than twice were included in Meta analysis.Meta analysis showed that within positive scoring group,family member education level,family member gender,patient awareness,ICU treatment time and family member uncertainty about the disease were factors affecting migration stress of ICU transfer patients'families(P<0.05);In reverse calculation group,educational level of family member,gender of family member,age of patient and ICU treatment time were influencing factors of migration stress of family members of ICU transfer patients(P<0.05).Sensitivity analysis result showed that result of each factor was relatively stable.Conclusion Educational level of family member,gender of family member,age of patient,ICU treatment time,uncertainty of family member's illness are influencing factors of migration stress of family members of patients transferred out of ICU in China.Influence of family member's religious beliefs and patient's consciousness needs further demonstration.

OBJECTIVE To explore the influential factors for “Internet +” prescription circulation and construction specifications of prescription circulation platform， so as to provide reference for the government to formulate relevant policies and standardized construction of prescription circulation platform. METHODS Stakeholders in the process of prescription circulation service in medical institutions in Sichuan province were selected to conduct key insider interviews， and grounded theory was used to analyze the data. RESULTS The influential factors of prescription circulation could be divided into three aspects： participant factor， administrative decision factor and information technology factor. The influential factors of prescription circulation mainly lay in pharmacy admission and withdrawal mechanism， medical insurance reimbursement service， supporting policies and pharmaceutical care ability. In terms of pharmacy admission and withdrawal mechanism， pharmacy qualification， pharmaceutical service personnel， drug allocation and distribution should be considered to unify pharmacy admission standards； in terms of medical insurance reimbursement service， it should actively connect with social pharmacies to realize the transfer of prescription medical insurance reimbursement from designated pharmacies； in terms of supporting policies， it should pay attention to the construction of the top-level design of prescription circulation； in terms of pharmaceutical care ability， regular training and assessment of licensed pharmacists should be performed in drug consultation， prescription review and other pharmaceutical care. CONCLUSIONS Participants have more influence on prescription circulation， and pharmacy admission and withdrawal mechanism and pharmaceutical care ability need to be improved. There are various types of prescription circulation platform construction， but each has its own advantages and disadvantages. It is suggested that relevant government departments should improve the access threshold of pharmacies， follow up medical insurance reimbursement services and supporting policies， and explore ways to improve pharmaceutical care capacity， leading and issuing relevant policies and measures to promote the prescription circulation service and make the “Internet +” prescription circulation develop in an orderly manner.

Objective:To detect the expression of ARK5 in peripheral blood circulating tumor cells (CTCs) from pancreatic cancer patients and explore its correlation with the efficacy and prognosis for gemcitabine chemotherapy.Methods:A total of 175 peripheral blood samples of pancreatic cancer patients who were treated in the Department of Hepatobiliary Surgery, Second Affiliated Hospital of Jiaxing University from January 2016 to June 2021 were collected. CTCs were enriched by nano-microfluidic chip technology. The expression of ARK5 in CTCs was detected by immunofluorescence. According to the expression of ARK5, the patients were divided into two groups: positive group and negative group. The differences on clinicopathological features, the efficacy of chemotherapy, median survival and progression-free survival time between the two groups were compared.Results:CTCs were enriched in 98 of 175 patients (55.6%), including 70 ARK5 positive and 28 ARK5 negative patients. There were no significant differences on clinical features between the two groups, and the two groups were comparable. In the 70 ARK5 positive patients, 64 patients (91.4%) were resistant to gemcitabine, while only 12 of the 28 ARK5 negative patients (42.8%) were resistant to gemcitabine. The incidence of gemcitabine resistance in ARK5 positive patients was significantly higher than that in ARK5 negative patients, and the difference was statistically significant ( P<0.001). The median survival time was 11.5 months in ARK5 positive group and 14 months in ARK5 negative expression group, and the progression-free survival time was 6 months in ARK5 positive expression group and 8 months in negative expression group. The survival time of ARK5 positive group was significantly shorter than that of ARK5 negative group, and the difference was statistically significant ( P<0.05). Conclusions:The pancreatic cancer patients with ARK5 positive CTCs have significantly higher incidence of gemcitabine resistance and shorter survival time than those with ARK5 negative CTCs. Detection of ARK5 expression in CTCs may be a new method to judge chemotherapy efficacy and prognosis for pancreatic cancer patients.

Background: The impact of para-aortic lymphadenectomy (PALD) on prognosis and quality of life (QoL) for IB2-IIA2 cervical cancer patients remain controversial. And whether intraoperative frozen pathology exam on common iliac lymph nodes could help predict para-aortic lymph node (PALN) metastasis was unanswered with high-level evidence. Methods A multi-center, randomized controlled study is intended to investigate the effect of PALD on the prognosis and QoL in cervical cancer patients and to assess the value of intraoperative frozen pathological evaluation of common iliac nodes metastasis for the prediction of PALN metastasis. After choosing whether to receive intraoperative frozen pathological examination of bilateral common iliac lymph nodes, eligible patients will be randomly assigned (1:1) to receive PALD or not. The primary end point is 2-year progression-free survival (PFS). The secondary end points include 5-year PFS, 2-year overall survival (OS), 5-year OS, adverse events (AEs) caused by PALD, AEs caused by radiotherapy and QoL. A total of 728 patients will be enrolled from 8 hospitals in China within 3-year period and followed up for 5 years.

Objective:To quantitatively analyze the protein expression changes of the optic nerve in an SD rat model of non-arteritic anterior ischemic optic neuropathy (NAION), and to make bioinformatics analysis of the differential proteins.Methods:Ten 8-week-old SPF male SD rats with a body mass of 200-250 g were selected.The NAION model was established using the method of rose bengal and laser photodynamics.Four from the 8 rats with successful model were selected as the NAION model group.Another 4 body weight- and age-matched healthy SD rats without eye diseases were taken as the normal control group.The optic nerve was dissected on the 7th day after modeling.The samples were prepared by the enzyme digestion method, and the proteins were identified and quantitatively detected by isobaric tag for relative and absolute quantification labeling combined with liquid chromatography-tandem mass spectrometry.The proteins with expression fold greater than 1.5 times and significant differences between the two groups ( P<0.05) were defined as differentially expressed proteins and analyzed by bioinformatics.The use and care of animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by the State Science and Technology Commission of China.The study protocol was approved by an Animal Ethical and Welfare Committee of Tianjin Medical University Eye Hospital (No.TJYY2021041029). Results:Three days after modeling, the optic disc of rats was swollen and fluorescein leakage in the optic disc was detected in fluorescein fundus angiography images in the NAION model group, which indicated the model was established successfully.A total of 1 291 quantifiable proteins including 80 differentially expressed proteins were identified.Compared with the normal control group, there were 5 up-regulated proteins and 75 down-regulated proteins.The expression levels of collagen alpha-1(V) chain (Col5A1), cAMP-dependent protein kinase catalytic subunit beta (Prkacb) and disks large homolog 1(Dlg1) were increased, and the expression levels of neurofilament medium polypeptide (Nefm), microtubule-associated protein 1B (Map1b), Ras-related protein Ral-A (Rala), serine/threonine-protein kinase N2 (Pkn2) and platelet-activating factor acetylhydrolase IB subunit beta (Pafah1b1) were decreased.Differentially expressed proteins were mainly involved in the biological processes, including regulation of the cytoskeleton, cellular response to hypoxia, axon production and extension, regulation of synapse, regulation of neuron apoptosis and axo-dendritic transport, etc.KEGG pathway enrichment analysis showed that differentially expressed proteins were mainly involved in metabolic pathways, synaptic vesicle circulation and platelet activation.Conclusions:The expression of proteins related to signal pathways such as nerve growth, energy metabolism, axo-dendritic transport and apoptosis is involved in the apoptosis of neurons in NAION.

Objective:To investigate the predictive value of YKL-40 at admission on stroke-associated pneumonia (SAP) and poor outcome in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to Taixing People’s Hospital from February 2020 to March 2021 were enrolled prospectively. The poor outcome was defined as 3-6 points on the modified Rankin Scale at 90 d after onset. Multivariate logistic regression analysis was used to determine the independent predictors of SAP and poor outcome, and the predictive value of serum YKL-40 on SAP and poor outcome was evaluated by receiver operating characteristic (ROC) curve. Results:A total of 377 patients with AIS were enrolled. The median serum YKL-40 was 127.16 μg/L. One hundred and four patients (27.6%) had SAP, and 126 (33.4%) had poor outcomes at 90 d after onset. Multivariate logistic regression analysis showed that after adjusting for confounding factors, YKL-40 was the independent predictors of SAP (odds ratio [ OR] 1.005, 95% confidence interval [ CI] 1.003-1.008; P=0.001) and poor outcome at 90 d ( OR 1.009, 95% CI 1.006-1.011; P=0.001). The ROC curve analysis showed that the area under the curve of YKL-40 for predicting SAP was 0.769 (95% CI 0.713-0.824; P<0.001), the best cutoff value was 168.70 μg/L, and the sensitivity and specificity were 71.2% and 75.1% respectively; the area under the curve of YKL-40 for predicting poor outcome at 90 d was 0.787 (95% CI 0.735-0.840; P<0.001), the best cutoff value was 195.56 μg/L, and the sensitivity and specificity were 68.3% and 84.1% respectively. Conclusion:Higher serum YKL-40 at admission has a good predictive value for SAP and poor outcome at 90 d in patients with AIS.