OBJECTIVE To investigate the effects of parthenolide （PLT） on systemic inflammation and intestinal injury in rats with acute pancreatitis （AP） by regulating the Kelch-like epichlorohydrin-associated protein 1 （Keap1）/nuclear factor-erythroid-2 related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway. METHODS AP rat model was established by injecting 3.5% sodium taurine cholate solution （1 mL/kg） into the biliary pancreatic duct， and modeled rats were divided into AP group， PLT （300 µg/kg） group， dexamethasone （2 mg/kg） group， inhibitor （11 mg/kg Nrf2 inhibitor ML385） group， and PLT+inhibitor group （300 µg/kg PLT+11 mg/kg ML385）， with 10 rats in each group. Another 10 rats were taken as a sham operation group. Each group was given relevant medicine or normal saline via tail vein/intraperitoneal injection once. After 24 h， serum lipase and amylase levels， the levels of oxidative stress index [superoxide dismutase （SOD） and malondialdehyde （MDA）] and inflammatory factors [interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α）] were detected. The histopathological changes in colon mucosa and pancreas were observed， and Chiu and Schmidt scores were performed. The cell apoptosis in colon mucosa and the protein expressions of Keap1， Nrf2 and HO-1 were detected. RESULTS Compared with the sham operation group， there was obvious inflammatory cell infiltration in colon mucosa and pancreatic tissue， cell shedding or tissue necrosis and severe bleeding； serum levels of lipase， amylase， MDA， IL-1β， IL-6 and TNF-α， Chiu and Schmidt scores， apoptotic rate and protein expression of Keap1 in colonic mucosa were significantly increased or up-regulated， while SOD level and protein expressions of Nrf2 20230993） and HO-1 were decreased or down-regulated significantly （P＜0.05）. Compared with the AP group， the above indexes in the PLT group and dexamethasone group were significantly improved， while those in the inhibitor group further deteriorated （P＜0.05）. Inhibitor could significantly reverse the improvement effect of PLT on the above indexes in AP rats （P＜ 0.05）. CONCLUSIONS PLT inhibits inflammation and oxidative stress in AP rats， alleviates intestinal damage， and its mechanism may be related to inhibiting protein expression of Keap1 and activating Nrf2/HO-1 signaling pathway.

【Objective】 To investigate the development of adaptability in children aged 2 - 6, and to explore its influencing factors, so as to provide reference for promoting the development of adaptability in young children. 【Methods】 Data were from the National Nutrition and Health Systematic Survey for Children in China, and 3 319 children aged 2 - 6 and their parents from 28 sites across 14 provinces were recruited in this study.The Development Scale for Children Aged 0 - 6 years (WS/T 580-2017) was used to measure the developmental quotient of children′s adaptive ability, and a survey questionnaire was used to collect relevant information about children and their parents. 【Results】 Among 3 319 children aged 2 - 6, the proportion of slightly low or low level of adaptability, moderate adaptability development, good and excellent adaptability development was 7.68%,66.25% and 26.06%, respectively.The proportion of children aged 5 - 6 with good and excellent adaptability was lower in 3-year-old and 4-year-old groups (χ²=59.29, P<0.05).Multiple stepwise linear regression showed that children′s gender (β=0.06), gestational age of birth (β=-0.05), only child (β=-0.04), left-behind child (β=-0.04), the main caregiver (β=-0.06), and the education level of parents (β=0.09, 0.10), whether parents actively pay attention to children′s emotions (β=-0.06) and whether children play with homemade toys (β=-0.04) were the influencing factors of children′s adaptive development quotient.Girls, full-term children, only children, non-left-behind children, children with parents as main caregivers, parents with a high level of education, parents who often take the initiative to pay attention to children′s emotions, and children who play with homemade toys had a higher level of adaptability development quotient. 【Conclusions】 The development level of adaptability in children aged 2 - 6 in China is mostly above the average level and is related to multiple factors.Targeted intervention work can be carried out on relevant factors in order to promote the development of children′s adaptability.

Objective To use metabolomics method to study the metabolic profiles of amino acids and lysophosphatidylcholine(LPC)in the serum of rats with nonalcoholic fatty liver disease(NAFLD),to identify biomarkers for NAFLD,and to speculate on the possible mechanism responsible for its occurrence.Methods NAFLD rats were prepared by feeding a high-fat diet and intraperitoneal injection of carbon tetrachloride.Levels of 15 LPCs and 18 amino acids in the serum were determined in control and NAFLD rats by liquid chromatography-mass spectrometry.Changes in serum LPC and amino acid metabolic profiles in NAFLD rats were analyzed by principal component analysis and orthogonal partial least squares discriminant analysis.Correlations between biomarkers and NAFLD were analyzed by Pearson's correlation analysis.Results The metabolic profiles of serum LPC and amino acids differed significantly between the NAFLD group and the control group and were completely distinct.LPC(20∶1),arginine,and glutamic acid had significant contributions to NAFLD and were identified as biomarkers.Furthermore,LPC(20∶1)and arginine were significantly correlated with serum biochemical indicators such as aspartate transaminase,alanine transaminase,low-density lipoprotein,and total bilirubin.Conclusions The metabolic profiles of serum LPC and amino acids may be closely related to NALFD.

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 understand the characteristics of long-working hours exposure of medical staff,and analyze the impact of long-working hours exposure on mental health problems such as occupational stress,depression,fatigue accumulation,and insomnia.Methods The cluster random sampling method was used to select the medical staff of 12 tertiary general hospitals in Guangdong Province as the research subjects,and the"Core Scale of Occupational Stress Measurement"and other scales were used to evaluate their occupational mental health.Results The average working hours of medical staff per day were(8.99±2.18)h;2,094 people were exposed during long working hours,accounting for 78.96%.The results of binary logistics regression analysis showed that after excluding the influence of sociodemographic factors such as age,long working hours(weekly working hours greater than 40 h)were the risk factors for occupational stress,depressive symptoms and fatigue accumulation of medical staff(P<0.01),and the longer the working week,the higher the risk of occupational stress,depressive symptoms and fatigue accumulation.Weekly working hours greater than 48 hours are risk factors for insomnia(P<0.01).Conclusion Long working hours are common among delivery workers on food delivery platforms,and long working hours are a risk factor for occupational tension and fatigue.

Objective:To investigate the influencing factors for underdiagnosis of high-grade squamous intraepithelial lesion (HSIL) of the uterine cervix and cervical cancer by colposcopy.Methods:The clinical data of 957 patients who underwent colposcopy and were diagnosed as HSIL or cervical cancer by histopathology at the Second Hospital of Shanxi Medical University from January 2017 to June 2022 were retrospectively analyzed, and logistic regression was used to analyze the influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy.Results:The results of univariate analysis showed that the underdiagnosis of HSIL and cervical cancer by colposcopy was related to whether or not menopause was present, whether or not there was coitus bleeding, whether or not there was irregular bleeding, liquid-based thin-layer cytology test (TCT) results, the morphology of the uterine cervix, the results of acetowhitening test, the results of iodine test, whether or not there was cuffed crypt (gland) openings, whether or not there was mosaicism, whether or not there was punctate vessels, whether or not the transformed zone was completely visible, the type of transformed zone, and whether or not the lesions involved the glands (all P < 0.05), but the underdiagnosis didn't related to whether or not there was human papillomavirus (HPV) infection, whether or not there was high-risk HPV multiple infections and the results of endocervical curettage (all P > 0.05). The results of multivariate logistic regression analysis showed that irregular bleeding ( OR = 4.279, 95% CI 2.170-8.441, P < 0.001), atypical squamous cells of uncertain significance (ASC-US) by TCT ( OR = 0.415, 95% CI 0.226-0.761, P = 0.004), atypical squamous cells, cannot exclud high-grade squamous intraepithelial lesion (ASC-H)/HSIL by TCT ( OR = 0.389, 95% CI 0.206-0.735, P = 0.004), thick acetowhite epithelium by acetowhitening test ( OR = 0.015, 95% CI 0.004-0.055, P < 0.001), and punctate vessels ( OR = 0.327, 95% CI 0.173-0.616, P = 0.001) were independent influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy. Conclusions:A history of irregular bleeding is a risk factor for underdiagnosis of HSIL of the uterine cervix and cervical cancer by colposcopy, while TCT results of ASC-US, ASC-H/HSIL and colposcopic visualization of thick acetowhite epithelium and punctate vessels could reduce the risk of underdiagnosis

The understanding of heart embryonic development and structure can contribute to improve our leaning of the etiology, pathophysiology and classification of congenital heart disease in humans, which has become the focus of echocardiography teaching. Meanwhile the difficulties and problems formed because of its diverse and fragmented theoretical knowledge. "Hand as foot" teaching method is a kind of teaching method using intuitive body language combined with the thought of analogy, so as to make teaching content relatively simplistic and figurative. Our study has demonstrated this method can be used in a constructive way to improve course content and delivery for echocardiography teaching to assess patent foramen ovale for standardized residency training of cardiac ultrasound, and achieved a good teaching effect. The specific implementation approaches and effect of this method are described in detail. This paper also explores the potential feasibility and benefits of the application of using "Hand as foot" teaching method in echocardiography teaching.

Objective:To investigate the current application of colonoscopy at hospitals in China.Methods:From November 2019 to January 2020, an online questionnaire survey was conducted among gastroenterologists and colonoscopists in hospitals of different levels. The contents of questionnaire survey included basic information of colonoscopy at the respondent′s hospital, protocols and patient education of bowel preparation, implementation of colonoscopy quality control, and colonoscopists′ understanding of polypectomy techniques and post-polypectomy follow-up.Results:A total of 236 valid questionnaires were collected, involving 187 hospitals, and 143 (76.5%) had an annual operation capacity of more than 5 000 cases. In terms of bowel preparation, split-dosed polyethylene glycol electrolyte powder (PEG) was the most commonly used (60.4%, 113/187) and the most common volume of PEG was 3 L (67.4%, 126/187). Verbal (90.9%, 170/187) and written (79.7%, 149/187) instructions were given more often than other methods for patient education of bowel preparation. Antifoaming agent was routinely used in 124 (66.3%) hospitals. In terms of quality control, only 11.5% (20/174) hospitals implemented all four measures. In terms of polypectomy techniques, 98.1% (203/207) colonoscopists chose hot snare polypectomy or endoscopic mucosal resection for lesions of diameter>1 cm, while options varied for lesions of diameter<1 cm. The interval of follow-up after polypectomy recommended by colonoscopists was shorter than that by guidelines.Conclusion:Several problems are found in the survey in the application of colonoscopy in China, i. e., patient education of bowel preparation is not diversified; quality control of colonoscopy still needs to be strengthened; polypectomy techniques and follow-up after polypectomy need to be further standardized.

Chimeric antigen receptor T (CAR-T) cell has achieved excellent efficacy in hematological tumors, especially for lymphoma. Many products have been approved to market all over the world, and 2 products targeting CD19 have been approved to treat relapsed and refractory large B-cell lymphoma in China. The current experiences of using CAR-T cells come from previous clinical studies. How to use CAR-T cells in a standardized and rationalized way is still a challenge faced by our clinicians. Based on the CAR-T cell treatment experiences from Peking University Cancer Hospital and the latest research progresses in CAR-T in China and abroad, this article will elaborate on patient screening, peripheral blood mononuclear cell collection, bridging treatment, lymphocyte depletion chemotherapy, CAR-T cell infusion, the monitoring and treatment of adverse events after infusion, and long-term follow-up after infusion, in order to guide clinicians to better use CAR-T cell and to bring maximum benefits to patients.

Objective Bushen-Qingxin decoction combined conjugated estrogen tablets of modulation perimenopausal women osteoporosis patients, explore the impact of bone mineral density and bone metabolic markers. Methods A total of 160 female patients were recruited in our hospital by the random number table method, and were divided into the control group 80 cases and the observation group 80 cases. The control group was treated with standard dose of conjugated estrogen tablets, while the observation group was treated with Bushen Qingxin decoction on the basis of the control group. Both groups were treated 3 period with 28 days per period. The enzyme-linked immunity analyzer was used to detect serum bone-specific alkaline phosphatase (BALP), C-terminal cross linked peptide (CTX-Ⅰ), tartrate resistant acid phosphatase -5b (TRACP-5b) level, and the dual-energy X-ray absorptiometry measurement method was used to detect bone mineral density values. The clinical curative effect was compared between two groups. Results The total effective rate of the observation group was 91.3%, while the control group was 78.8%, which showed the difference was statistically significant (χ 2=3.971, P=3.971). After treatment, the serum BALP levels (88.55 ± 10.33 U/L vs. 80.47 ± 8.67 U/L, t=5.399) of the observation group were significantly higher than this of the control group (P<0.01). After treatment, the serum TRACP-5b (501.31 ± 35.77 pg/L vs. 538.51 ± 37.69 pg/L, t=6.498), CTX- (130.09 ±Ⅰ17.55 ng/ml vs. 164.71 ± 19.45 ng/ml, t=11.928) of the observation group were significantly lower than those of the control group (P<0.01). After treatment, the bone mineral density of the observation group rose up from the baseline (t=3.396, P=0.010). Conclusions The Bushen-Qingxin decoction combined conjugated estrogen tablets can increase on women in the menopausal transition of osteoporosis in patients with bone mineral density values and serum BALP levels, reduce serum TRACP-5b, CTX-Ⅰ level.