ObjectiveTo investigate the mechanism of Baihuan Xiaoyao Decoction （Xiaoyaosan added with Lilii Bulbus and Albiziae Cortex） in alleviating depression-like behaviors of juvenile rats by regulating the polarization of microglia. MethodSixty juvenile SD rats were randomized into normal control， model， fluoxetine， and low-， medium-， and high-dose （5.36， 10.71， 21.42 g·kg^-1， respectively） Baihuan Xiaoyao decoction groups. The rat model of juvenile depression was established by chronic unpredictable mild stress （CUMS）. The sucrose preference test （SPT） was carried out to examine the sucrose preference of rats. Forced swimming test （FST） was carried out to measure the immobility time of rats. The open field test （OFT） was conducted to measure the total distance， the central distance， the number of horizontal crossings， and the frequency of rearing. Morris water maze （MWM） was used to measure the escape latency and the number of crossing the platform. The immunofluorescence assay was employed to detect the expression of inducible nitric oxide synthase （iNOS， the polarization marker of M1 microglia） and CD206 （the polarization marker of M2 microglia）. Real-time polymerase chain reaction was employed to determine the mRNA levels of iNOS， CD206， pro-inflammatory cytokines ［tumor necrosis factor （TNF）-α， interleukin （IL）-1β， and IL-6］ and anti-inflammatory cytokines （IL-4 and IL-10） in the hippocampus. Western blotting was employed to determine the protein levels of iNOS and CD206 in the hippocampus. The levels of IL-4 and IL-6 in the hippocampus were detected by enzyme-linked immunosorbent assay. ResultCompared with the normal control group， the model rats showed a reduction in sucrose preference （P<0.05）， an increase in immobility time （P<0.05）， decreased motor and exploratory behaviors （P<0.05）， and weakened learning and spatial memory （P<0.05）. In addition， the model rats showed up-regulated mRNA and protein levels of iNOS and mRNA levels of IL-1β， IL-6， and TNF-α （P<0.05）. Compared with the model group， Baihuan Xiaoyao decoction increased the sucrose preference value （P<0.05）， shortened the immobility time （P<0.01）， increased the motor and exploratory behaviors （P<0.05）， and improved the learning and spatial memory （P<0.01）. Furthermore， the decoction down-regulated the positive expression and protein level of iNOS， lowered the levels of TNF-α， IL-1β， and IL-6 （P<0.01）， promoted the positive expression of CD206， and elevated the levels of IL-4 and IL-10 （P<0.01） in the hippocampus of the high dose group. Moreover， the high-dose Baihuan Xiaoyao decoction group had higher sucrose preference value （P<0.01）， shorter immobility time （P<0.01）， longer central distance （P<0.01）， stronger learning and spatial memory （P<0.01）， higher positive expression and protein level of iNOS （P<0.01）， lower levels of TNF-α， IL-1β， and IL-6 （P<0.05， P<0.01）， lower positive expression and mRNA level of iNOS （P<0.05）， and higher levels of IL-4 and IL-10 （P<0.05， P<0.01） than the fluoxetine group. ConclusionBaihuan Xiaoyao decoction can improve the depression-like behavior of juvenile rats by inhibiting the M1 polarization and promoting the M2 polarization of microglia in the hippocampus.

Objective: To analyze the association between dietary inflammatory index (DII) and gallstone disease among middle-aged and elderly population, so as to provide the evidence for the prevention and control of gallstone disease. Methods: Baseline survey data were collected from the Shanghai Women's Health Study (SWHS) and Shanghai Men's Health Study (SMHS), including demographic information, gallstone disease prevalence and dietary habits. DII was calculated using 29 kinds of food parameters associated with common inflammatory biomarkers and food intake data of residents. A multivariable logistic regression model was used to analyze the association between dietary inflammatory index and gallstone disease. Results: A total of 132 312 individuals were included in the analysis. There were 59 627 males and 72 685 females. Among males, the median age was 53.07 (interquartile range, 9.73) years, 41 544 cases (69.67%) had an educational level of middle school, 4 463 cases (7.48%) had gallstone disease, and DII was -6.46 to 5.59. Among females, the median age was 50.27 (interquartile range, 9.05) years, 47 380 cases (65.19%) had an educational level of middle school, 8 090 cases (11.13%) had gallstone disease, and DII was -6.44 to 4.93. Multivariable logistic regression analysis showed that after adjusting for age, educational level, income level, smoking, alcohol consumption, tea consumption, physical activity and menopausal status (only for females), DII (OR=1.095, 95%CI: 1.002-1.196) was associated with an increased risk of gallston disease among males, but no statistically association was found among females (P>0.05). Conclusion DII might be associated with an increased risk of gallstone disease among middle-aged and elderly population.

OBJECTIVE In order to analyze the current situation of policy tool allocation in China’s TCM formula granule industry， and provide a theoretical basis for the high-quality development of the industry. METHODS Based on the perspective of policy tools，“ TCM formula granules” was used as the keyword to retrieve the official websites of departments directly under the State Council such as the National Medical Products Administration and the National Administration of Traditional Chinese Medicine， as well as provincial governments. The relevant clauses in the policy documents related to TCM formula granules in China from 1993 to 2022 were encoded， and then the application of policy tools was summarized and classified. RESULTS & CONCLUSIONS A total of 12 national documents and 77 provincial documents were ultimately selected， involving 556 relevant policy clauses. It was found that among the relevant policy tools， environmental policy tools had the highest degree of attention， accounting for 62.6%； the proportions of demand-oriented policy tools and supply-oriented policy tools were less， accounting for 17.8% and 19.6%， respectively. From the perspective of policy tools， the use of demand-oriented policy tools in current policy texts was relatively simple， and various policy tools were given low attention； from the perspective of policy objectives， the proportion of use of environmental， demand-oriented and supply-oriented policy tools were not balanced enough. It is suggested to increase the proportion of demand- oriented policy tools to meet international competition； emphasize the use of supply-oriented policy tools to strictly control product quality； consolidate the use of environmental policy tools to standardize quality standards. On this basis， we will coordinate the overall situation， balance the use of various policy tools and promote the development of TCM formula granule industry.

ObjectiveTo explore the mental health status and its influencing factors among middle school students in Xide County， Liangshan Yi Autonomous Prefecture， and to provide references for mental health interventions for local middle school students. MethodsUsing a cross-sectional study design， one junior middle school and one senior middle school in Xide County， Liangshan Prefecture， Sichuan Province， were randomly selected on September 16， 2021， and two classes per grade in each school involving 288 students were recruited. Subjects were assessed using Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， Generalized Anxiety Disorder Scale-7 item （GAD-7）， PTSD Checklist for DSM-5 （PCL-5）， Multidimensional Scale of Perceived Social Support （MSPSS） and UCLA Loneliness Scale （ULS-3）. Then the scores of above scales were compared among middle school students with different demographic characteristics， and binary Logistic regression analysis was conducted to screen the influencing factors of post-traumatic stress disorder (PTSD） symptoms. ResultsAmong the respondents， 17.71% （95% CI： 0.133~0.221）， 8.68% （95% CI： 0.054~0.120）， 2.78% （95% CI： 0.009~0.047） and 45.83% （95% CI： 0.400~0.516） were reported to have symptoms of depression， anxiety， PTSD and loneliness， respectively. Students in senior middle school scored lower on PCL-5 and ULS-3 than those in junior middle school ［（6.46±8.91） vs. （8.87±9.42）， t=2.202， P<0.05； （4.67±1.65） vs. （5.60±1.88）， t=4.431， P<0.01］. Regression analysis denoted that depressive symptoms （OR=7.630， P<0.05） and anxiety symptoms （OR=3.789， P<0.01） were risk factors for PTSD symptoms among middle school students. ConclusionThe middle school students in Xide County， Liangshan Yi Autonomous Prefecture suffer a high prevalence rate of depressive symptoms and loneliness， and those in junior middle school are more likely to feel a sense of strong loneliness， furthermore， depressive symptoms and anxiety symptoms are risk factors for PTSD symptoms.

Objective:This work aims to assess the distribution of peripheral blood monocyte subsets, the expression level of the functional markers in rheumatoid arthritis (RA) patients, and analyze the correlation between the above indexes and the onset of RA.Methods:Peripheral blood mononuclear cells were collected and isolated from 62 RA patients, 52 healthy control (HC) and 12 disease control group′s patients via density centrifugation. The enrolled patients were attended or underwent physical examination in East Hospital, Tongji University from June 2020 to December 2021. Monocytes could be classified into classical (CM), intermediate (IM) and non-classical (NCM). Then, the flow cytometry was performed to examine the distribution of monocyte subsets and the measure the expression level of human leukocyte antigen DR (HLA-DR), intracellular tumor necrosis factor α (TNF-α) in peripheral blood monocytes. The statistical methods in this study mainly include: Kruskal-Wallis H test, Chi-Square test, Mann-Whitney U test, Wilcoxon matched-pairs signed ranks test, Spearman correlation coefficient test and Logistic regression analysis. The diagnostic value of IM proportion in RA was analyzed by ROC curve. Results:The monocytes number and monocytes proportion in white blood cells were much higher in RA [0.40 (0.40, 0.50), 7.60% (5.97%, 8.53%)] and disease control [0.40 (0.40, 0.68), 8.20% (5.85%, 10.28%)] compared with HC [0.30 (0.30, 0.40), 5.80% (5.03%, 6.38%)] ( H=24.733, P<0.001; H=27.469, P<0.001). A statistic-significant difference was detected among the proportion of CM[85.49%(76.91%,89.21%),88.94%(86.36%,91.72%),90.26%(80.25%, 92.56%)],IM[11.65%(8.47%,17.89%),7.89%(5.36%,10.75%), 5.56%(4.17%, 8.27%)], NCM[2.22%(1.39%, 3.74%), 2.49%(1.74%, 4.66%), 5.13%(3.39%, 9.85%)] in RA group, HC group and disease control group ( H=11.389, P=0.003; H=20.815, P<0.001; H=10.640, P=0.005). The proportion of CM was lower in RA and the IM proportion was increased in RA( P=0.003; P=0.003). The intracellular TNF-α level of monocytes in all three groups revealed the trend that IM>NCM>CM. The intracellular TNF-α in IM of RA was positively associated with serum TNF-α ( r=0.376, P=0.041). The HLA-DR expression in IM subsets were higher than CM and NCM subsets in all RA,HC and disease control groups. The expression of HLA-DR of IM in RA group and disease control was higher than HC group [8 611.50 (6201.3, 9890.8), 10 295.0 (7 899.0, 13632.0), 6 278.00(4 057.8, 9522.0), H=10.495, P=0.005]. There were no correlations between the proportion of peripheral blood IM and clinical characteristics CRP ( r=0.119, P=0.359), RF ( r=0.204, P=0.112) and ESR ( r=0.153, P=0.236). Logistic regression analysis showed that the proportion of IM ( OR=1.169, 95% CI 1.003-1.363, P=0.046), CRP ( OR=1.277, 95% CI 1.000-1.631, P=0.050), RF ( OR=1.179, 95% CI 1.080-1.287, P<0.001) are positively correlated with RA onset. The area under ROC curve for diagnosis of RA with IM proportion was 0.687, and the 95% confidence interval was 0.590-0.784, P<0.001. Conclusions:The distribution of monocyte subsets in peripheral blood of RA patients is abnormal. The increase in the proportion of IM, the enhanced antigen-presenting ability, and the increased level of TNF-α secretion in RA patients may play an important role in the pathogenesis of RA.

Objective:To measure with Zhejiang province as an example the situation of the self-evaluation health management service capability of primary medical staff in county-level medical alliances.Methods:A self-evaluation scale for health management service capability by primary medical staff was customized, covering 5 dimensions of professional attitude, interpersonal communication ability, comprehensive knowledge integration ability, professional practice ability and professional development ability, as well as 29 items. In July-September 2019, medical alliances were selected from three counties/cities based on economic development as the survey targets, and a total of 264 primary medical staff were surveyed. Quantitative data were described in mean and standard deviation, while qualitative data were described in composition ratio, and the differences were compared by Kruskal-Willis test.Results:The self-evaluation scoring of health management service capability of the primary medical staff was (59.75±18.64) points, and the average scoring of the items was (2.06±0.64) points. The scoring of knowledge integration (1.98±0.70)and professional practical ability (2.03±0.67) were lower than the average scoring of the items; gender and occupation type of primary medical staff present statistical significances in the self-evaluation scoring of health management service capability.Conclusions:Given the health management service capabilities of primary medical staff, they still need to upgrade their knowledge integration and professional practice capabilities. County-level medical alliances should enhance their training of health management knowledge and skills, promote doctor-nurse collaboration in health management services to broaden the depth of primary health management services.

Objective To investigate the serum IL-33 level and its association with TH1,TH2,TH17 and Treg cells in patients with unexplained recurrent spontaneous abortion(URSA).Methods Forty-six URSA patients and 40 healthy controls were enrolled.The proportions of TH1,TH2,TH17 and Treg cells in peripheral blood samples were determined by flow cytometry,and serum IL-33 levels by ELISA.Results The levels of serum IL-33 in URSA patients were significantly lower than that in healthy controls.The proportions of TH2 and Treg cells in URSA patients were significantly lower than that in healthy controls (P ＜ 0.05),while the proportions of TH 1 and TH 17 cells in URSA patients were significantly higher than that in healthy controls.Serum IL-33 levels were negatively correlated with the proportions of TH 1 and TH17 cells,and positively with that of TH2 cells,while no correlation with Treg cells.Conclusion Serum IL-33 levels decrease significantly in URSA patients,and are correlated with the proportions of TH1,TH2 and TH17 cells,indicating that IL-33 may be associated with TH1,TH2 and TH17 cells in URSA patients.

Acute Disease ; Adult ; Female ; Humans ; Mesenteric Ischemia ; etiology ; surgery ; Pregnancy ; Pregnancy Complications ; surgery ; Protein S Deficiency ; complications ; Remission Induction

Objective To explore the effect of Vitamin K1(Vit K1), fresh frozen plasma (plasma) andcryoprecipitate on prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen original(Fbg), thrombin time (TT) of newborns with different gestational ages. Methods The serum of 1,134 newbornsfrom The Third Affiliated Hospital of Guangzhou Medical University was collected from February 2009 to September2012. All newborns had been divided into four groups (according to the gestational age of 28-31+6 weeks, 32-33+6weeks, 34-36+6 weeks and gestational age≥37 weeks).The effect of various interventions (Vit K1, Vit K1+plasmaand Vit K1+cryoprecipitate) on PT, APTT, Fbg, and TT had been recorded. Results (1)The PT and APTT ofeach group with the interventions of Vit k1 were significantly improved (P < 0.05). (2)The PT, APTT, Fbg and TTof each group with the interventions of Vit k1 combined with plasma were significantly improved (P < 0.05). (3)ThePT, APTT and Fbg of each group with the interventions of Vit k1 combined with cryoprecipitate were significantlyimproved (P < 0.05). (4)With Vit k1 combined with plasma, PT and APTT were mostly improved and Fbg wasimproved mostly with Vit k1 combined with cryoprecipitate. Conclusion Vitamin K1, fresh frozen plasma andcryoprecipitate can effectively improvedin the coagulation index of newborns with different gestational ages.

Objective To investigate the clinical characteristics of primary gastrointestinal lymphoma (PGIL) on different origin site in order to improve its diagnosis.Methods The clinical data from 202 patients with PGIL diagnosed by histology from January 1999 to June 2007 were identified from the clinical databases of 8 hospitals in Wuhan area and retrospectively analyzed.The patients were divided into gastric,small intestinal and large intestinal lymphoma groups according to the site of origin and there clinical characteristics were compared.Results The PGIL localization was gastric in 113 (56.0%) cases, small intestine in 37(18.3%) cases and large intestine in 52 (25.7%) cases.One hundred and thirty (64.4%) were males and 72 (35.6%) were females.The male patients were predominant.The median duration of symptoms in gastric lymphoma group was longer than small intestinal lymphoma group (3.0 months vs.1.0 month,P=0.013).The most common symptoms were abdominal pain and anemia. The clinical stage was Ⅰ E and Ⅱ E in 71.3% of cases.The large intestinal lymphoma group presented more advanced-stage disease compared with gastric lymphoma group (P = 0.014).The frequent histological type was mucosa-associated lymphoid tissue lymphoma (MALT),diffuse large B-cell lymphoma and T-cell lymphoma.Gastric,small intestinal and large intestinal lymphomas presented more frequently as low-grade MALT lymphoma (56.9%),T-cell lymphoma (34.4%) and high-grade B-cell lymphoma (51.1%),respectively (all P value ＜0.05).The common macroscopic type of PGIL were nodular protruding and ulcerative type.Compared with gastric lymphoma,nodular protruding type was more common and ulcerative type was less common in large intestinal lymphoma (P = 0.000).The diagnosis confirmed by endoscopic biopsy were 58.7% (61/104),25.0% (4/16),48.2% (13/27) in gastric,small intestinal and large intestinal lymphoma groups,respectively.Conclusions The clinical characteristics are different in patients with different localization of PGIL including patient characters, initial symptoms,histological classification,clinical stage,macroscopic feature,endoscopic findings. Analysis of these clinical characteristics is helpful to improve its diagnosis.