Objective : To investigate the protective effect of dimethyl fumarate(DMF) on maternal intrahepatic cholestasis(ICP) during pregnancy induced by di(2-ethylhexyl) phthalate(DEHP) exposure and its mechanism. Methods : Thirty-two 8-week-old female institute of cancer research(ICR) mice were randomly divided into 4 groups: Ctrl group, DEHP group, DMF group and DEHP+DMF group. DEHP and DEHP+DMF groups were treated with DEHP(200 mg/kg) by gavage every morning at 9:00 a.m. DMF and DEHP+DMF groups were treated with DMF(150 mg/kg) from day 13 to day 16 of gestation by gavage. After completion of gavage on day 16 of pregnancy, maternal blood, maternal liver, placenta, and amniotic fluid were collected from pregnant mice after a six-hour abrosia. The body weight of the mother rats and the body weight of the fetus rats were sorted and analyzed; the levels of total bile acid(TBA), alkaline phosphatase(ALP), aspartate aminotransferase/alanine aminotransferase(AST/ALT) in serum and TBA in liver, amniotic fluid and placenta were detected by biochemical analyzer; HE staining was used to observe the pathological changes of liver tissue; Quantitative reverse transcription PCR(RT-qPCR) was used to detect the expression levels of tumor necrosis factor-α(TNF-α), interleukin(IL)-6, IL-1, IL-18 and NOD-like receptor thermal protein domain associated protein 3(NLRP3) in the liver; Western blot was used to detect the expression of the nuclear factor KappaB(NF-κB) and NLRP3. Results : Compared with the control group, the body weight of the DEHP-treated dams and pups decreased(P<0.05); the levels of TBA, ALP, AST/ALT in the serum of dams and the levels of TBA in the liver, amniotic fluid, and placenta of dams increased(P<0.05); the histopathological results showed that liver tissue was damaged, bile ducts were deformed, and there was inflammatory cell infiltration around them; the levels of inflammation-related factors TNF-α, IL-6, IL-1, IL-18 and NLRP3 transcription in maternal liver increased(P<0.05); the expression of NF-κB and NLRP3 protein in maternal liver significantly increased( P<0. 05). Compared with the DEHP group,the body weight of both dams and fetuses significantly increased in DEHP + DMF group( P<0. 05); the levels of TBA,ALP,AST/ALT in the serum of dams and amniotic fluid of fetuses decreased( P<0. 05); the degree of liver lesions was improved; the transcription levels of inflammation-related factors TNF-α,IL-6,IL-1,IL-18 and NLRP3 in maternal liver decreased( P<0. 05); the expression of NF-κB and NLRP3 protein in maternal liver significantly decreased( P<0. 05). Conclusion DMF can effectively protect the DEHP exposure to lead to female ICP,and its mechanism may be through inhibiting the NF-κB/NLRP3 pathway and reducing liver inflammation.

Congenital heart disease (CHD) is a congenital malformation resulting from abnormal embryonic development of the heart and great vessels, accounting for approximately 25% of all congenital malformations. Children with CHD are often complicated by short stature. Although surgical treatment can improve their growth and development to a certain extent, some children still experience growth retardation after surgery. Recombinant human growth hormone (rhGH) is the main drug for treating short stature, but its efficacy and safety in the treatment of patients with concomitant CHD warrant further investigation. This article reports six cases of children with CHD and short stature who were treated with rhGH. Through a literature review, we summarize and discuss the therapeutic efficacy, follow-up experiences, and adverse reactions of rhGH treatment, aiming to provide references for clinicians in applying rhGH to treat patients with CHD and short stature.

AIM: To explore the efficacy of 0.05% cyclosporine A combined with olopatadine eye drops in treating allergic conjunctivitis-related dry eye disease.METHODS: A total of 63 patients(63 eyes)with allergic conjunctivitis-related dry eye disease in the People's Hospital of Guangxi Zhuang Autonomous Region from August 2022 to April 2023 were enrolled and randomly divided into control group(n=33)and observation group(n=30). The patients of the control group were administrated with 0.1% olopatadine eye drops and 0.3% sodium hyaluronate eye drops, while the observation group was administrated with 0.1% olopatadine eye drops and 0.05% cyclosporine A eye drops. The ocular surface disease index(OSDI), total ocular symptom score(TOSS), conjunctival congestion score, conjunctival papillae and follicle score, Schirmer I test(SⅠt), tear meniscus height(TMH), meibomian gland secretion ability and property score, meibomian gland loss area score, corneal fluorescein staining(CFS), tear film break-up time(BUT), noninvasive first tear film break-up time(NIBUTf), noninvasive average tear film break-up time(NIBUTav)before and after treatment and the drug safety during the treatment period of both groups of patients were evaluated.RESULTS: After treatment, OSDI, TOSS, conjunctival congestion score, conjunctival papillae and follicle score, SⅠt, TMH, meibomian gland secretion ability score and property score, CFS, BUT, NIBUTf, and NIBUTav of the observation group showed improvements compared with those before treatment(all P<0.017). Among these, OSDI, TOSS, conjunctival congestion score, conjunctival papillae and follicle score, BUT, NIBUTf, and NIBUTav demonstrated significant improvement compared with the control group(all P<0.05). There was no statistically significant difference in meibomian gland loss area score between the two groups before and after treatment(P>0.05). During the treatment period, there were no local or systemic adverse reactions.CONCLUSION: The combined use of 0.05% cyclosporine A and olopatadine eye drops can significantly improve ocular discomfort symptoms of patients with dry eye disease associated with allergic conjunctivitis, such as red eyes, itchy eyes and foreign body sensation, promote tear film stability and have high safety.

Objective: To investigate the prevalence of sleep quality among the elderly in nursing homes in Changning District, Shanghai Municipality, so as to provide insights into prevention and intervention strategies for improving sleep quality and overall quality of life for the elderly. Methods: The elderly from 25 nursing homes in Changning District were selected using a two-stage sampling method. Basic information including gender, age and types of medication were collected. Sleep quality was assessed using the Athens Insomnia Scale, and depressive symptoms were measured using the Geriatric Depression Scale. Factors affecting sleep quality among the elderly in nursing homes were analyzed using a multivariable logistic regression model. Results: A total of 739 participants were surveyed, including 516 males (69.82%) and 223 females (30.18%). The majority of participants were aged 80 to <90 years (478, 64.68%). Among them, 432 participants (58.46%) had normal sleep, 144 (19.49%) had suspected insomnia, and 163 (22.06%) had insomnia. Multivariable logistic regression analysis showed that older age (OR=1.030, 95%CI: 1.005-1.055), more medication types (OR=1.971, 95%CI: 1.381-2.812), frequent nighttime bathroom visits (OR=2.921, 95%CI: 1.853-4.605) and depressive symptoms (OR=3.295, 95%CI: 2.440-4.449) were associated with a higher risk of insomnia among the elderly in nursing homes. Conclusions Insomnia was reported in 22.06% of the elderly in nursing homes in Changning District. Age, the number of medication types, frequency of nighttime bathroom visits, and depressive symptoms are the main influencing factors for their sleep quality.

Objective:Based on the needs of advanced nursing practice development, to establish an indicator system of role function of position of oncology genetic nurses suitable for our national condition, and to provide a basis for position establishing of nocology genetic nurses.Methods:Initial indexes were generated through the literature review and semi-structured interviews. From September to December 2022, two rounds of expert consultations and analytic hierarchy process were conducted to establish the evaluation index for role function of position of oncology genetic nurses.Results:A total of 43 experts were included in the study, the response rates of 2 rounds were 93.62%(44/47) and 97.73%(43/44), and the authority coefficients of the experts were 0.821 and 0.853. The Kendall′s coefficients of concordance for the 2 rounds of consultations were 0.100-0.150 (all P<0.01) and 0.101-0.237 (all P<0.01). Finally, the role function system of position for oncology genetic nurses was formed, which consisted of 5 first-level indexes, 17 second-level indexes and 86 third-level indexes. Conclusions:The system of role function of position for oncology genetic nurses is reasonable, scientific and reliable, professional and specific, which can provide a theoretical reference for the development of advanced nursing practice on hereditary oncology in China.

Objective To explore the high-quality development path of tertiary public hospitals and provide scientific reference for deepening the reform of public hospitals.Methods Based on SPO theory,it constructed an analytical framework for the high-quality development of tertiary public hospitals,collected data of a quarterly monitoring in-dex for the performance assessment and high-quality development of tertiary public hospitals in a certain province in 2023,and analysed 73 tertiary public hospitals participating in the performance assessment as the object of analy-sis,and adopted the fuzzy-set Qualitative Comparative Analysis to explore different condition sets of high-quality de-velopment of tertiary public hospitals and reveal the path of high-quality development of public hospitals.Results High-quality development is the result of multi-factor interaction.Four configurations were identified to promote the high-quality development of tertiary public hospitals:service quality-technology-driven path,service quality-driven path,comprehensive service-driven path,and service quality-benefit-driven path.Quality safety and functional orientation were found to be the core elements in promoting high-quality development of public hospitals.Conclusion Hospitals at all levels should strengthen the guidance of party building,combine with the actual functional positioning,take quality and safety as the core,and optimize the combination conditions of technical level,personnel structure,service process,and cost control.It is essential to clarify the development strategy of hospitals,implement the dynamic concept,and realize the high-quality development of public hospitals.

Objective To explore the high-quality development path of tertiary public hospitals and provide scientific reference for deepening the reform of public hospitals.Methods Based on SPO theory,it constructed an analytical framework for the high-quality development of tertiary public hospitals,collected data of a quarterly monitoring in-dex for the performance assessment and high-quality development of tertiary public hospitals in a certain province in 2023,and analysed 73 tertiary public hospitals participating in the performance assessment as the object of analy-sis,and adopted the fuzzy-set Qualitative Comparative Analysis to explore different condition sets of high-quality de-velopment of tertiary public hospitals and reveal the path of high-quality development of public hospitals.Results High-quality development is the result of multi-factor interaction.Four configurations were identified to promote the high-quality development of tertiary public hospitals:service quality-technology-driven path,service quality-driven path,comprehensive service-driven path,and service quality-benefit-driven path.Quality safety and functional orientation were found to be the core elements in promoting high-quality development of public hospitals.Conclusion Hospitals at all levels should strengthen the guidance of party building,combine with the actual functional positioning,take quality and safety as the core,and optimize the combination conditions of technical level,personnel structure,service process,and cost control.It is essential to clarify the development strategy of hospitals,implement the dynamic concept,and realize the high-quality development of public hospitals.

Objective To investigate the current situation of home environment safety of the elderly in Changning District, identify the risk factors related to the fall of the home environment of the elderly, and take targeted rectification measures, so as to create a safer environment for the elderly. Methods A phased random sampling method was used to select 201 elderly households from 10 streets in Changning District. Community doctors conducted on-the-spot investigation and assessment to collect information, and Epidata3.1 was used to input data and SAS 9.2 was used for statistical analysis. Results The incidence of falls in the past year was 19.90%, and the score of environmental risk factors/the number of environmental risk factors in each family ranged from 0 to 25, with an average of 9 items (standard deviation of 4.71). The results of multivariate logistic regression analysis show that the high level of falling environment (the number of falling risk factors in home environment ≥12) is still an independent risk factor for falls of the elderly, except for the influence of age and the number of drugs taken (OR=3.835, 95% CI:1.718-8.561). Conclusion The environmental risk factors causing falls are common in the home environment of the elderly in the community. It is necessary to focus on improving the home environment, reducing the risk of falls for the elderly, and creating a safe and comfortable home environment for the elderly.

Cyclosporine A, a cyclic polypeptide, exhibits potent immunosuppressive activity and exerts its effects through various mechanisms including immunosuppression, anti-inflammatory, inhibition of apoptosis, promotion of epithelial healing and goblet cell function recovery, enhancement of tear secretion, and close association with ocular surface disease repair. Owing to its significant efficacy, inhibition of disease recurrence and few side effects, the clinical application of cyclosporine A in the management of ocular surface diseases, including dry eye, corneal graft rejection following penetrating keratoplasty, vernal keratoconjunctivitis, noninfective keratitis and herpes simplex virus keratitis, has witnessed a substantial rise in recent years. Nevertheless, variations exist in the management of ocular surface inflammatory diseases when utilizing distinct concentrations and dosage forms of cyclosporine A. Therefore, the paper provides an overview of impacts of cyclosporine A on ocular surface diseases.

Objective To investigate the protective effect of folic acid against cholestatic liver injury in mice induced by bis(2-ethylhexyl)phthalate(DEHP)exposure and its mechanism.Methods ICR mice were randomly divided into control group,high-dose folic acid(H-FA)group,DEHP group,DEHP+low-dose folic acid(DEHP+L-FA)group,and DEHP+high-dose folic acid(DEHP+H-FA)group,with 6 mice in each group.The mice in the H-FA group,the DEHP+L-FA group,and the DEHP+H-FA group were given folic acid by gavage at the corresponding dose,and those in the control group and the DEHP group were given an equal volume of PBS solution by gavage.After 2 hours,the mice in the DEHP group,the DEHP+L-FA group,and the DEHP+H-FA group were given corn oil containing 200 mg/kg DEHP,and those in the control group and the H-FA group were given an equal volume of pure corn oil,by gavage for 4 weeks.Body weight and food intake were recorded every day,and blood and liver tissue samples were collected.A biochemical analyzer was used to measure the serum levels of total bile acid(TBA)and alkaline phosphatase(ALP);HE staining was used to observe the histopathological changes of liver tissue;kits were used to measure the content of malondialdehyde(MDA)and superoxide dismutase(SOD)in the liver;LC-MS/MS was used to measure serum bile acid profiles;Western blot was used to measure the expression levels of proteins associated with hepatic bile acid metabolism.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups.Results Compared with the control group,the daily food intake of the mice in the DEHP group decreased significantly,and the body weight decreased significantly from day 10(P＜0.05),and compared with the DEHP group,the DEHP+L-FA group and the DEHP+H-FA group had basically unchanged body weight and daily food intake(P＞0.05).Compared with the control group,the DEHP group had significant increases in liver weight index and the serum levels of TBA and ALP(all P＜0.05),with enlarged portal area,bile duct deformity and hyperplasia,and a small amount of inflammatory cell infiltration in liver tissue;compared with the DEHP group,the DEHP+L-FA group and the DEHP+H-FA group had a significant reduction in liver weight index(P＜0.01),and the DEHP+H-FA group had significant reductions in the serum levels of TBA and ALP(P＜0.05),with a significant improvement in liver histomorphology and structure after folic acid intervention.Compared with the control group,the DEHP group had a significant reduction in the content of SOD(P＜0.05)and a significant increase in the content of MDA in the liver(P＜0.01),and compared with the DEHP group,the DEHP+H-FA group had significant reductions in the content of MDA and SOD(P＜0.05).Compared with the control group,the DEHP group had significant increases in the serum levels of α-muricholic acid(α-MCA),β-muricholic acid(β-MCA),deoxycholic acid(DCA),lithocholic acid(LCA),taurocholic acid(TCA),taurodeoxycholic acid(TDCA),tauroursodeoxycholic acid(TUDCA),tauro-β-muricholic acid(T-β-MCA),tauro-α-muricholic acid(T-α-MCA),taurohyodeoxycholic acid(THDCA),and taurolithocholic acid(TLCA)(P＜0.05)and a significant reduction in ursodeoxycholic acid(UDCA)(P＜0.05);compared with the DEHP group,the DEHP+H-FA group had significant reductions in the serum levels of DCA,LCA,TCA,TDCA,TUDCA,T-β-MCA,T-α-MCA,THDCA,and TLCA(P＜0.05).Compared with the control group,the DEHP group had significant increases in the protein expression levels of FXR and CYP3A11 in the liver(P＜0.01)and significant reductions in the protein expression levels of CYP7A1 and MRP2(P＜0.01);compared with the DEHP group,the DEHP+L-FA group and the DEHP+H-FA group had significant reductions in the protein expression levels of FXR and CYP3A11 in the liver(P＜0.05)and a significant increase in the protein expression level of MRP2(P＜0.05),and the DEHP+H-FA group had a significant increase in the protein expression level of CYP7A1(P＜0.05).Conclusion Folic acid has a protective effect against cholestatic liver injury in mice induced by DEHP exposure,possibly by regulating bile acid synthesis,catabolism,and transport and maintaining bile acid homeostasis.