OBJECTIVE To re-evaluate the use of systematic evaluation/meta-analysis of anti-VEGF drugs in the treatment of diabetic macular oedema （DME）， aiming to provide evidence-based support for the clinical application of this medication. METHODS A comprehensive search was conducted across a range of databases， including CNKI， Wanfang data， VIP， CBM， PubMed， Web of Science， Embase， and Cochrane Library. The objective was to identify systematic evaluation/meta-analysis of anti- VEGF drugs for DME， with search time from the inception of the databases to March 2024. The report quality， methodological quality， and evidence quality were assessed by using PRISMA2020 statement， AMSTAR2 scale and GRADE tool. A comprehensive analysis of systematic evaluation/meta-analysis results was also conducted. RESULTS A total of 22 articles were included. According to the PRISMA2020 statement evaluation， 13 studies provided relatively complete information （≥21 points）， while 9 studies had information deficiencies （18-＜21 points）. The AMSTAR 2 scale evaluation revealed that 21 studies had very low methodological quality， and one study had low methodological quality. The GRADE tool evaluation showed that out of 89 outcome indicators， 28（ 31.46%） were classified as high-quality evidence， 34（ 38.20%） as moderate-quality evidence， 24（ 26.97%） as low- quality evidence， and 3 （3.37%） as very low-quality evidence. The comprehensive quality analysis results demonstrated that， compared with laser photocoagulation， anti-VEGF drugs significantly enhanced the improvement in best-corrected visual acuity （BCVA）， as well as significant change in retinal thickness at 1 and 6 months， and 1 and 2 years post-treatment， and also in BCVA and retinal thickness at 1， 3， and 6 months post-treatment （P＜0.05）. Compared with placebo， patients treated with anti-VEGF drugs showed significant improvement in BCVA after 1 year of treatment （P＜0.05）. However， when compared with corticosteroid drugs， patients treated with anti-VEGF drugs exhibited a significant increase in retinal thickness after 6 months of treatment （P＜0.05）. Compared with corticosteroid drugs， the incidence of adverse events related to the eyes， cataract formation and intraocular pressure were significantly decreased in patients treated with anti-VEGF drugs （P＜0.05）. Compared with laser photocoagulation， the incidence of ocular adverse events was significantly decreased in patients treated with anti-VEGF drugs， while the incidence of fatal adverse events was significantly increased （P＜0.05）. CONCLUSIONS Anti-VEGF therapy for DME may possess certain advantages in terms of efficacy and safety， but it is associated with a higher risk of fatal adverse events； the evidence included in systematic reviews/meta-analyses is of moderate to high quality.

OBJECTIVE To develop a population pharmacokinetic （PPK） model for mycophenolate mofetil active metabolite mycophenolic acid （MPA） in children with primary IgA nephropathy， explore the factors affecting the pharmacokinetic parameters of MPA， and provide a basis for clinical individualized therapy. METHODS Retrospective collection was conducted on 636 concentrations and clinical data from 47 pediatric patients with primary IgA nephropathy. PPK analysis was carried out by using the nonlinear mixed-effects model； the covariates were tested with a stepwise method. Goodness-of-fit plots， Bootstrap and visual predictive check were employed to evaluate the final model. RESULTS The pharmacokinetics of MPA in children with IgA nephropathy in vivo conformed to the first-order absorption and elimination two-compartment model （objective function value of 3 276.31）. Covariate analysis suggested that body weight and albumin （ALB） levels were significant influencing factors on apparent clearance rate and apparent distribution volume. The typical values of PPK parameters of MPA in the final model were as follows： the central room had a distributed volume of 5.79 L， the clearance rate was 4.06 L/h， the volume of peripheral ventricular distribution was 430.93 L， the clearance rate between compartments was 15.40 L/h， the oral absorption rate constant was 1.29 h－1. After verification， most of the predicted corrected observed concentration points were within the 90% confidence interval of the predicted corrected simulated concentration， indicating that the MPA final model had good predictive performance. CONCLUSIONS The PPK model of MPA in children with primary IgA nephropathy is established in this study， identifying body weight and ALB levels are significant factors affecting MPA metabolism.

Objective To investigate the inhibitory effect of toosendanin on the growth of lung adenocarcinoma cells in vitro and in vivo by regulating the expression of cell division cycle associated protein 5(CDCA5).Methods The expression of CDCA5 in different lung tissues was analyzed in TCGA database.The expression level of CDCA5 in BEAS-2B cells and A549 cells was detected by Western blot.The effect of different concentrations of toosendanin on the viability of A549 cells was determined by cell counting kit-8(CCK-8)assay.The A549 cells were randomly divided into 4 groups:control group(normal cells cultured normally),toosendanin group(normal cells cultured with 40 μmol·L-1 toosendanin),toosendanin+pcDNA group(cells transfected with pcDNA empty vector and cultured with 40 μmol·L-1 toosendanin),and toosendanin+CDCA5 group(cells transfected with CDCA5 overexpression vector and cultured with 40 μmol·L-1 toosendanin).After 48 h of cultivation,the proliferation and apoptosis of each group of cells were detected by CCK-8 and flow cytometry,and the expression of proliferation and apoptosis related proteins in each group of cells was detected by Western blot.The BALB/c nude mice were randomly divided into sh-NC and sh-CDCA5 stable transfected cell lines with nude mouse xenograft models.Daily intraperitoneal injection of 0.9％NaCl and 40μmol·L-1 toosendanin solution was given to observe and record the changes in tumor tissue volume and body mass.Results The results of CCK-8 showed that after 48 hours,the survival rates of A549 cells treated with 10,20,30,40,50,60 and 70 μmol·L-1 toosendanin were(80.74±8.71)％,(72.96±6.53)％,(61.01±4.86)％,(51.20±3.13)％,(42.10±5.94)％,(38.93±3.18)％and(33.48±2.94)％,respectively.Toosendanin significantly inhibited the proliferation of A549 cells.The proliferation rates of cells in the control group,toosendanin group,toosendanin+pcDNA group,and toosendanin+CDCA5 group were(100.00±4.19)％,(49.18±6.70)％,(55.75±5.74)％,and(77.66±7.48)％,respectively;the expression levels of CDCA5 protein were 1.08±0.11,0.44±0.04,0.43±0.05 and 0.99±0.10,respectively.The expression levels of CDCA5 protein in tumor tissues of nude mice in the sh-NC group,sh-CDCA5 group,toosendanin+sh-NC group,and toosendanin+sh-CDCA5 group were 1.04±0.14,0.42±0.04,0.56±0.08 and 0.32±0.04,respectively.Compared with the sh-NC group,the tumor blocks formed by nude mice in other groups were significantly smaller,and the tumor volume and weight were significantly lower(all P＜0.05).Compared with the toosendanin+sh-NC group,the toosendanin+sh-CDCA5 group had more significant inhibitory effect on tumor formation,and the difference was statistically significant(P＜0.05).Conclusion Toosendanin can inhibit the growth of lung adenocarcinoma cells in vitro and in vivo,which is mainly related to the inhibition of CDCA5 expression.

To understand Helicobacter pylori's drug resistance,genetic diversity,and relationship with clinical diseases in the Guiyang and Qiannan minority areas of Guizhou Province,we collected samples through endoscopy,and isolated and cul-tured H.pylori.The drug resistance and genotype characteristics were determined.The differences in different regions and dis-ease types were compared,and the structural characteristics of H.pylori and mixed infections with different strains of H.py-lori in Qiannan Prefecture were analyzed.A difference in the composition ratio of EPYIA typing in the cagA variable region was observed between the two areas(P=0.012),and the composition ratio of the vacA genotype differed(P=0.000).A total of 94.6％(53/56)new sequences of H.pylori strains from two regions were obtained by MLST.The rate of infection by H.pylori mixed with different strains was 44.4％in Qiannan Pre-fecture,and no significant difference was observed in the com-position of H.pylori mixed infections among patients with dif-ferent clinical diseases(P=0.349).Differences in EPI YA typ-ing and the vacA genotype composition ratio in the cagA varia-ble region of H.pylori were observed between the Qiannan Prefecture and Guiyang City.

Objective To investigate the impacts of LINC00943 on proliferation,apoptosis,and invasion of esophageal squamous cell carcinoma(ESCC)cells by regulating the miR-126-5p/HOXB2 axis.Methods QRT-PCR was applied to detect the expression of LINC00943 in 45 ESCC tissues and cell lines;The effects of LINC00943 knockdown on the proliferation,apoptosis and invasion of KYSE30 cells were detected by MTT assay,flow cytometry and Transwell chamber.Western blot was applied to detect the expression of proliferating cell nuclear antigen(PCNA),Bcl-2 associated X protein(Bax),anti apoptotic factor B cell lymphomatoma-2(Bcl-2),cleaved caspase-3,matrix metalloproteinase-2(MMP-2),MMP-9,and HOXB2;dual luciferase reporter gene experiment was applied to verify the relationship between miR-126-5p and LINC00943 and HOXB2;the ESCC nude mouse in vivo model was constructed and separated into si-NC and si-LINC00943 groups,the tumor mass and volume were measured,qRT-PCR was applied to detect the expression of miR-126-5p in transplanted tumor tissue,immunohistochemistry was applied to detect the expression of HOXB2 protein in transplanted tumor tissue,and TUNEL staining was applied to detect cell apoptosis in tumor tissue.Results The expression of LINC00943 mRNA increased in ESCC tissues and cell lines(P＜0.05);Compared with the si-NC group,the proliferation activity,migration and invasion cell number,HOXB2,PCNA,MMP-2,MMP-9 and Bcl-2 protein expression of KYSE30 cells in the si-LINC00943 group were decreased,and the expression of miR-126-5 p,Bax,Cleaved Caspase-3 and apoptosis rate were increased(P＜0.05);downregulation of miR-126-5p was able to weaken the inhibitory effect of LINC00943 knockdown on the malignant behavior of KYSE30 cells(P＜0.05);dual luciferase reporter gene experiment confirmed the targeted regulatory relationship between miR-126-5p and LINC00943,and miR-126-5p and HOXB2(P＜0.05);The ESCC nude mouse model was constructed in vivo and divided into si-NC and si-LINC00943 groups.The tumor mass,tumor volume,expression of miR-126-5p and HOXB2 in transplanted tumor tissues and apoptosis rate of tumor cells were measured.(P＜0.05).Conclusion LINC00943 is highly expressed in ESCC tissues and cell lines.Knocking down LINC00943 may inhibit the expression of HOXB2 by up-regulating the expression of miR-126-5p,promote the apoptosis of ESCC cells,and inhibit their proliferation,migration and invasion.

In infants with severe bronchopulmonary dysplasia(sBPD),severe pulmonary lobar emphysema may occur as a complication,contributing to significant impairment in ventilation.Clinical management of these infants is extremely challenging and some may require lobectomy to improve ventilation.However,prior to the lobectomy,it is very difficult to assess whether the remaining lung parenchyma would be able to sustain adequate ventilation postoperatively.In addition,preoperative planning and perioperative management are also quite challenging in these patients.This paper reports the utility of selective bronchial occlusion in assessing the safety and efficacy of lobectomy in a case of sBPD complicated by severe right upper lobar emphysema.Since infants with sBPD already have poor lung development and significant lung injury,lobectomy should be viewed as a non-traditional therapy and be carried out with extreme caution.Selective bronchial occlusion test can be an effective tool in assessing the risks and benefits of lobectomy in cases with sBPD and lobar emphysema.However,given the technical difficulty,successful application of this technique requires close collaboration of an experienced interdisciplinary team.

Objective:This study aims to analyze the spatial-temporal patterns,evolutionary trends,and regional balance of human resources in village clinics in China,providing a practical basis and decision-making reference for the construction of rural healthcare systems.Methods:By employing a variety of spatial-temporal statistical analysis methods,this study examines the spatial-temporal development and dynamic distribution trends of human resource allocation in village clinics.It explores the characteristics of resource allocation balance,and deconstructs the sources of regional,interregional,and intraregional disparities in human resource structures.Results:The total scale of human resources in village clinics decreased,but the number of personnel per thousand population and the proportion of health technicians increased.The human resources of village clinics in different provinces have gradually evolved to Twin Peaks,showing a convergence trend of spatial clubs.There is a significant difference in the allocation of human resources in village clinics,and the internal difference in the eastern region contributes the most,both within and between regions,the difference of health technical personnel has gradually become the main reason for the unbalanced allocation of village clinic space.Conclusion:The allocation of human resources in village clinics in China is facing the challenge of decreasing the total amount.The sustainability of the optimized allocation of personnel structure needs to be further enhanced,and the balance of the allocation of health technical personnel space has also been slightly improved,it is necessary to re-examine the total amount of human resources management in village clinics,promote the optimization of personnel structure and the complementarity of regional advantages,and reduce regional differences in the optimization of personnel structure.

Objective To explore the characteristics of vaginal microecology and vaginitis distribution of female patients in Xi'an,so as to provide reliable reference for clinical treatment.Methods A total of 102 124 women in Shaanxi Provincial People's Hospital from January 2018 to August 2023 were selected as the research objects.Vaginal secretions were collected from patients,and the vaginal microecology was detected and analyzed.Results Among 102 124 female patients,99.87%had vaginal microecological imbalance.The main disease types were vulvovaginal candidiasis(VVC),accounting for 16.03%,bacterial vaginitis(BV),accounting for 9.61%and trichomonal vaginitis(TV),accounting for 1.34%.Statistical analysis showed that the age of VVC,BV and TV patients was mainly 21～30 years old.The prevalence of VVC and BV in summer and autumn was higher than that in other seasons,while the prevalence of TV was relatively high in summer.In addition,there were 27 552 cases of simple vaginitis(26.98%)and 1 443 cases of mixed vaginitis(1.41%)in 101 995 female patients with vaginal microecology imbalance.In patients with mixed vaginitis,the BV+VVC combination accounted for the vast majority(79.00%),and the age group was mainly between 21 and 40 years old.Among the 28 995 patients with vaginitis,4 308 patients(14.86%)had recurrence,and the recurrence rate of simple vaginitis(11.44%,3 152/27 552)was much lower than that of mixed vaginitis(80.11%,1 156/1 443).Conclusion The main type of female simple vaginitis in Xi'an is VVC,which has a high prevalence in summer and autumn.The main type of mixed vaginitis is BV+VVC,Compared with simple vaginitis,patients with mixed infection are more likely to relapse.

Objective To investigate the incidence and severity of symptoms in patients with gastric cancer who received chemotherapy,we constructed a symptom network to explore core symptoms and bridge symptoms.Furthermore,the study explores the association between core symptoms and Traditional Chinese Medicine(TCM)constitutions.Methods Patients with gastric cancer who received chemotherapy in the medical oncology and surgical oncology department from March to August 2023 were selected for the study using a convenience sampling method.The MD Anderson Symptom Inventory Gastrointestinal Cancer was used for evaluating gastrointestinal symptoms and their severity among patients receiving chemotherapy for gastric cancer,as well as assessing the classification of TCM constitution among patients.The symptom network model was constructed using the R programming language,and the central index was analyzed to determine the core symptoms and bridge symptoms.Binary logistic regression analysis was employed to assess the association between different physical conditions and the occurrence of core symptoms.Results A total of 346 electronic questionnaires were collected,with 340 valid ones,and the effective recovery rate was 98.3％.The 3 most prevalent and severe symptoms among the 340 patients with gastric cancer were fatigue(85.59％),lack of appetite(82.35％),and taste alteration(81.18％).The centrality index results indicated that grief exhibited the highest intensity,medium,and compactness centrality values(rs=8.23,rb=2.00,rc=0.03),making it the core symptom of this condition.Sleep disorders,lack of appetite,drowsiness,and taste alteration were identified as bridging symptoms with bridge intensities of 0.74,0.76,0.99,and 0.94 respectively.The results of Spearman correlation analysis showed that there was a positive correlation between sadness and qi-deficiency constitution,phlegm-dampness constitution(P＜0.05).The phlegm-dampness constitution was positively correlated with the taste alterations(P＜0.05).Conclusion In patients with gastric cancer,fatigue emerges as the most prominent symptom,while sadness assumes the core symptom.Additionally,sleep disorder,lack of appetite,drowsiness,and taste alteration are bridge symptoms.According to the principles of TCM constitution,qi-deficiency and phlegm-dampness are constitutions associated with a higher risk of experiencing sadness,and phlegm-dampness is a constitution associated with a higher risk of taste changes.Nurses can integrate core symptoms and TCM constitutions characteristics to optimize the strategies for symptom intervention.

Objective:To explore the effects of traditional Chinese medicine nursing protocols for type 2 diabetes mellitus on the level of frailty and self-management in patients with type 2 diabetes mellitus, so as to provide new ideas for intervention of diabetic frailty and improvement of self-management.Methods:From January 2021 to June 2021, the 100 patients with type 2 diabetes mellitus in the department of Endocrinology of the First Affiliated Hospital of Anhui University of Chinese Medicine were treated with the traditional Chinese medicine nursing protocols for type 2 diabetes mellitus issued by the State Administration of Traditional Chinese Medicine using the quasi experimental research method. General information questionnaire, Tilburg Frailty Indicator(TFI), Summary of Diabetes Self-Care Activities (SDSCA), Chinese-Diabetes Management Self-Efficacy Scale(C-DMSES) and the effect evaluation scale of traditional Chinese medicine nursing protocols for diabetes mellitus (type 2 diabetes mellitus) were investigated on 1 to 2 days after admission, at discharge, 3 months after discharge and were analyzed by t test, analysis of variance, SNK test. Results:The TFI scores of patients were (4.90 ± 2.44), (3.89 ± 1.99), (3.43 ± 2.22) points, the SDSCA scores were (41.31 ± 14.30), (57.90 ± 12.73), (52.33 ± 12.71) points, the C-DMSES scores were (128.99 ± 32.18), (154.69 ± 25.43), (141.27 ± 27.86) points, the effect scores of traditional Chinese medicine nursing protocols for type 2 diabetes mellitus were (13.40 ± 6.02), (6.98 ± 5.04), (5.01 ± 3.96) points at 1-2 days after admission, discharge, and 3 months after discharge, there were statistically significant differences among different time periods ( F values were 11.14-72.50, all P<0.05). The fasting blood glucose and 2-hour postprandial blood glucose of patients were (9.28 ± 3.51), (7.16 ± 1.66), (7.24 ± 1.76) mmol/L and (14.93 ± 4.22), (10.28 ± 4.83), (10.30 ± 2.25) mmol/L at 1-2 days after admission, discharge and 3 months after discharge, and the differences were statistically significant ( F = 21.02, 37.55, both P<0.05). Conclusions:The implementation of traditional Chinese medicine nursing protocols for type 2 diabetes mellitus can delay the degree of frailty of type 2 diabetes mellitus, improve the level of self-management of patients, help patients control blood glucose, with good traditional Chinese medicine nursing effect, worthy of clinical application.