Objective: To explore the impact of household tobacco smoke exposure on adolescents attempted smoking behavior, so as to provide a reference for tobacco control policy formulation and evaluation. Methods: From September to November 2023, a stratified cluster random sampling method was employed to select 7 841 middle and high school students from 10 monitoring sites (districts/counties) in Beijing for a questionnaire survey. Rao-Scott Chi square test was used to assess differences in proportions across subgroups, and complex sampling design based multivariate Logistic regression analysis was conducted to explore the influence of parental smoking and secondhand smoke (SHS) exposure at home on adolescents attempted smoking behavior. Results: About 47.17% of adolescents reported to have at least one parent smoked, with 42.36% reported of having only the father smoked, 0.73% reported of having only the mother smoked, and 4.08% reported of having both parents smoked. About 34.66% of middle and high school students were reported SHS exposure at home in the past 7 days, with 10.98%, 4.79% and 18.89% reported SHS exposure for 1-2, 3-4 and 5-7 days. Compared to adolescents with non smoking parents, those with a smoking father or both smoking parents had higher rates of attempted smoking [ OR (95% CI )=1.45(1.06-1.98), 3.73(2.18-6.37), P < 0.05 ]. Compared to adolescents without SHS exposure at home in the past 7 days, those exposed for 3-4 or 5- 7 days had higher rates of attempted smoking [ OR (95% CI )=2.21(1.27- 3.84 ), 2.46(1.58-3.83), P <0.01]. Conclusions Household tobacco smoke exposure is associated with adolescent attempted smoking behavior. Parents should quit smoking and prohibit smoking at home to create a smoke free environment for adolescents.

Objective To evaluate the clinical efficacy of Chevron minimally-invasive osteotomy and internal fixation with ISO intramedullary plate plus traditional Chinese medicine(TCM)bone-setting manipulations for the treatment of moderate hallux valgus.Methods A retrospective study was conducted.A total of 49 patients(62 feet)with moderate hallux valgus were treated with Chevron minimally-invasive osteotomy and internal fixation with ISO intramedullary plate,and were given TCM bone-setting manipulations before the operation,during the operation,and after the operation.The efficacy was evaluated by using the Visual Analogue Scale(VAS)score and the American Orthopedic Foot and Ankle Society(AOFAS)forefoot score after the operation.Before the operation and 12 months after the operation,the hallux valgus angle(HVA),intermetatarsal angle(IMA)between the first and second metatarsal bone,and the distal metatarsal articular angle(DMAA)showed by X-ray imaging in the weight-bearing position of the foot were recorded.Results(1)All of the 49 patients were followed up for 12 to 24 months,with a mean of(20.6±3.1)months.(2)The X-ray imaging assessment showed that 12 months after the operation,the mean HVA,IMA and DMAA values of the 49 patients(62 feet)were significantly lower than those before the operation,and the differences were all statistically significant(P＜0.01).(3)Twelve months after the operation,the pain VAS score of 49 patients was(3.14±1.21)points,which was significantly lower than the preoperative score points(7.26±2.52),and the difference was statistically significant(P＜0.01).(4)The assessment of joint function showed that 12 months after the operation,the scores of various AOFAS items of pain,function and hallux alignment as well as the overall AOFAS scores of 49 patients were significantly higher than those before the operation,and the differences were statistically significant(P＜0.01).(5)For the 62 feet in 49 patients,the excellent efficacy was achieved in 53 feet,good efficacy was achieved in 7 feet,and fair efficacy was achieved in 2 feet,with the fine rate of 96.77%(60/62).Conclusion For the treatment of moderate hallux valgus,the application of Chevron minimally-invasive osteotomy and internal fixation with ISO intramedullary plate plus TCM bone-setting manipulations is effective on promoting the reset of hallux-metatarsophalangeal joint,restoring the balance of the joint,and maintaining the equilibrium state of the joint through postoperative rehabilitation guidance.The combined therapy exerts certain efficacy,reduces the recurrence rate,and eventually achieves the early rehabilitation after the operation.

Objective To observe the efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction complicated with heart failure.Methods A total of 78 patients with acute myocardial infarction complicated with heart failure admitted to the hospital from May 1,2020 to December 31,2022 were selected and divided into control group(n = 39)and study group(n = 39)by random number table method.In addition to basic treatment,the control group received levosimendan,and the study group ivabradine and levosi-mendan.The treatment period of both groups was 4 weeks.Compare two groups of patients'vital signs,clinical curative effect and heart function index,serological indexes,inflammatory factors and security.Results Compared with before treatment,the systolic blood pressure,diastolic blood pressure and heart rate of the two groups were decreased after treatment(P<0.05),and the systolic blood pressure,heart rate,diastolic blood pressure and heart rate of the study group were significantly decreased compared with the control group(P<0.05).Compared with the control group,the total effective rate of the study group was significantly higher(P<0.05).Compared with before treatment,the levels of CO and LVEF were increased(P<0.05),while the levels of LVEDV and LVESV were decreased(P<0.05).Compared with the control group,the levels of CO and LVEF in the study group were higher(P<0.05),and the levels of LVEDV and LVESV in the study group were lower(P<0.05).Compared with before treatment,the levels of cTnI,sST2 and NT-proBNP in both groups were decreased after treatment(P<0.05),and the serum levels of cTnI,sST2 and NT-proBNP in the study group were significantly decreased compared with the control group(P<0.05).Tumor necrosis factor α(TNF-α),myeloperoxidase(MPO)and highly sensitive C-reactive protein(hs-CRP)were all decreased after treatment in the two groups(P<0.05),and those in the study group were much lower(P<0.05)No difference between the incidence of adverse reactions to the total contrast the two groups(P>0.05).Conclusion Levosimendan combined with ivabadinehave a definite effect on patients with acute myocardial infarction complicated with heart failure for the improved cardiac function,reduced inflammation,regulated serum sST2,cTnI,and NT-proBNP level.It is also safe and reliable

Objective To analyze the current status of medication therapy management(MTM)against the background of"Internet+"in China,to reveal its research hotspots and development trend through visual methods,and to provide a firm reference for promoting innovative pharmaceutical development and the transformation of pharmacists.Methods Using CiteSpace 6.2 R2,368 Chinese studies from the CNKI,CBM,and VIP databases were collected and analyzed.Relevant graphs were drawn,and the results were analyzed through post-trend,cooccurrence,cluster,and burst analysis.Results The number of articles issued in China's"Internet+"MTM field is on the rise.However,the cooperation network between authors and research institutions is relatively scattered.The research team led by tertiary hospitals has played an essential role in this field,but the medical consortium has not fully utilized its advantages.In addition,informatization and pharmacists are the research objects of continuous concern,while quality of life and diabetes are recent research hotspots.Conclusion"Internet+"MTM is a new medical service model involving multiple disciplines and fields.In this paper,CiteSpace 6.2 R2 performed a visual analysis of the literature on"Internet+"medication therapy management in China,revealing the research status,concerns,and development trends in this field,which has specific reference value for relevant policy formulation and research.

OBJECTIVE To investigate the intervention effect of Dabufei decoction on acute lung injury in rats with high altitude hypoxia by regulating the expression of the HIF-1α/NLRP3 signaling pathway and related molecules. METHODS Sixty SPF SD rats were randomly divided into blank group, model group, positive drug group, Dabufei decoction high-dose, medium-dose, and low-dose groups with 10 rats in each group. After 3 d of adaptation to feeding, the rats in the blank group and model group were given the same amount of normal saline by gavage, and the rats in Dabufei decoction high-dose, medium-dose, and low-dose groups were given gavage for 14 d, respectively. The positive drug group was given dexamethasone by intraperitoneal injection for three consecutive days before entering the chamber. Except for the blank group, the rats in each group were exposed to hypoxia in the experimental animal low-pressure simulation chamber from the 15th day for three consecutive days. At the end of the experiment, the wet to dry ratio(W/D) of the rat lung tissue was detected. The morphology of lung tissue was observed by HE staining. ELISA detected the levels of IL-1β and IL-18 in serum. Western blotting and RT-qPCR were used to detect the protein and mRNA expressions of HIF-1α, NLRP3, GSDMD, and caspase-1 in the lung tissue of rats. RESULTS The W/D value showed that compared with the blank group, the W/D of the model group was significantly increased(P<0.01). Compared with the model group, the W/D of rats in the positive drug group, Dabufei decoction high-dose group, medium-dose, and low-dose groups was significantly decreased(P<0.01 or P<0.05). HE results showed that compared with the blank group, alveolar septum thickening, pulmonary interstitial congestion, edema, inflammatory cell infiltration, and a small amount of exudation in the alveolar cavity were seen in the lung tissue of the model group. Compared with the model group, the thickening of alveolar walls in the positive drug group, Dabufei decoction high-dose group, medium-dose, and low-dose groups were reduced, and the pulmonary interstitial congestion, edema, and inflammatory cell infiltration were significantly reduced. ELISA results showed that IL-1β and IL-18 in rat serum were significantly higher in the model group than in the blank group(P<0.01). Compared with the model group, the levels of IL-1β and IL-18 in the serum of the rats in the positive drug group, Dabufei decoction high-dose group, medium-dose, and low-dose groups were significantly decreased(P<0.05 or P<0.01). Moreover, the results of Western blotting and RT-qPCR showed that compared with the blank group, the relative protein and mRNA expressions of HIF-1α, NLRP3, GSDMD, and caspase-1 in the lung tissue of the model group were significantly increased(P<0.01). Compared with the model group, the relative protein and mRNA of HIF-1α, NLRP3, caspase-1 and GSDMD in the positive drug group and Dabufei decoction high-dose group were significantly decreased(P<0.05 or P<0.01), the relative protein of HIF-1α, NLRP3, caspase-1 and GSDMD in Dabufei decoction medium-dose group were significantly decreased and HIF-1α, caspase-1 mRNA were significantly decreased(P<0.05), the relative protein of HIF-1α and GSDMD in the low-dose group was decreased(P<0.05). The positive drug group and Dabufei decoction high-dose group had the more significant effect. CONCLUSION Dabufei decoction can regulate the HIF-1α/NLRP3 signaling pathway, inhibit pyroptosis and reduce inflammation, and has a certain protective effect on acute lung injury in rats with high altitude hypoxia.

OBJECTIVE To investigate the implementation effects of the national centralized drug volume-based procurement policy （abbreviated as “national centralized procurement policy”） in Guangxi Zhuang Autonomous Region prefecture， and to provide a reference for the future centralized drug procurement work of the medical institution. METHODS Drug procurement data before and after policy implementation were included in the study. The six secondary indicators （such as availability， affordability， and drug safety） and eighteen third-level indicators （such as completion rate of agreed purchase volume， affordability level， drug revenue proportion） were introduced， guided by the policy objectives and issues of concern to policy beneficiaries. Descriptive statistics was adopted to analyze the data before and after policy implementation （in 2019 and 2020） in terms of differences and change trends. RESULTS In terms of accessibility， the participation rate of medical institutions in Guangxi Zhuang Autonomous Region was 92.55%， the proportion of diseases involved and median completed procurement rate were 40.16%， and 287.82% respectively， and the total centralized delivery rate was 97.20%. In terms of affordability， the total reduction amplitude in drug price was 74.80% from 2019 to 2022； the charge for medicine per capita in hospitalization， the proportion of medicine used for outpatient service and hospitalization， decreased by 17.61%， 10.22%， and 20.10% in order； the burden levels on medical fares for patients were all below 1 in addition to chronic diseases， and anti-tumor drugs. In terms of the impact on medicine， the ratio of adverse drug reaction event cases in 2022 was 66.00%， an increase of 1.29% compared to the previous； since the implementation of the policy， 12 drugs from local pharmaceutical enterprises from Guangxi Zhuang Autonomous Region had passed the consistency evaluation， and the market concentration rate of the top 8 pharmaceutical companies was less than 20.00%. In terms of the impact on healthcare and medical insurance， the public medical institutions achieved generic substitution for originator drugs mostly until 2022； about 9.12% of drugs that were non- centrally purchased in the same category were used； 63.39% of people under investigation did not show a need for a second dressing change； drug expenditure decreased by 2.459 billion yuan. CONCLUSIONS The national centralized procurement policy achieves a significant effect in Guangxi Zhuang Autonomous Region. On the other hand， attention should be paid to these suggestions as follows: expanding the category of drugs used in clinic， conducting clinically comprehensive evaluation of selected drugs， and improving reasonable allocation strategy， etc.

ObjectiveTo explore the effectiveness and safety of Yiqi Huoxue Formula （益气活血方， YHF） in the adjuvant treatment of chronic pulmonary heart disease （CPHD） and heart failure （HF）with qi deficiency and blood stasis pattern. MethodsOne hundred and twenty patients with CPHD and HF with qi deficiency and blood stasis pattern were allocated randomly into treatment group and control group， with 60 case in each group. The control group was given conventional basic western medicine， while the treatment group was given oral administration of YHF granules in addition， one dose per day. The treatment course for both groups was 8 weeks. The TCM symptom scores， Minnesota Life Quality Scale （MLHF-Q） scores， echocardiographic indicators including right ventricular end-diastolic diameter （RVEDD）， left ventricular end-diastolic diameter （LVEDD）， left atrial end-diastolic diameter （LAEDD） and pulmonary artery mean pressure （PAMP）， six-minute walking distance （6MWD）， and plasma N-terminal pro-B-type natriuretic peptide （NT-ProBNP） level were compared between the groups. The effectiveness regarding cardiac function and TCM syndromes were compared between the two groups after treatment， and the occurrence of adverse events was observed. ResultsWith two drop-outs both in the treatment group and control group， and 58 cases in each group were included in the outcome analysis. The total effective rate regarding cardiac function and TCM syndromes in the treatment group were 91.38% （53/58） and 96.55% （56/58）， respectively， significantly higher than the corresponding 70.69% （41/58） and 48.27% （28/58） in the control group （P＜0.05）. After treatment， the TCM symptom scores and RVEDD level were significantly reduced in the treatment group， and MLHF-Q score， plasma NT-ProBNP level and PAMP level decreased significantly， while 6MWD increased in both groups （P＜0.01）. Compared to those in the control group， the TCM symptom scores， MLHF-Q score， plasma NT-ProBNP level and PAMP level significantly decreased， while 6MWD increased in the treatment group （P＜0.01）. There were no obvious abnormalities in the blood， urine， stool routine and liver and kidney function indicators in both groups. One adverse reaction each occurred in both groups， and there was no statistically significant difference in the incidence rates（P＞0.05）. ConclusionYHF combined with conventional western medicine can significantly improve the clinical efficacy， improve the clinical symptoms and cardiac function， increase the quality of life and exercise tolerance， and is relatively safe.

Objective To investigate the distribution of the thalassemia genotypes and the characteristics of blood cell parameters in Changshou District,Chongqing.Methods Totally 4126 samples sent to our hospital were studied from June 2018 to March 2023.All samples were detected for thalassemia genotype and blood cells.The parameters of blood cells:redblood cell(RBC),hemoglobin(Hb),mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),mean corpuscular hemoglobin concentration(MCHC),red blood cell distribution width CV(RDW-CV),red blood cell distribution width SD(RDW-SD)were detected.Gap polymerase chain reaction(Gap-PCR)combined with reverse dot blot hybridization were used to detect alpha and beta thalassemia genotype.The rate and distribution characteristics of thalassemia gene in Changshou district were analyzed.Results Among 4126 samples,408 cases of α and β thalassemia were detected,accounting for 9.89%.Among these,there were 255 α-thalassemia cases.-α3.7/αα was the most common genotype.Two cases of--αSEA/-α3.7 and one cases of--SEA/HKαα were also detected.There were 153 cases of β-thalassemia and CD17 accounted for the highest proportion.The date of MCV,MCH,MCHC in-α3.7/αα,--SEA/αα,-α4.2/αα and ααCS/αα groups was significantly difference compared with control group(P<0.05).Parameters of MCV and MCH in CD17,CD41-42 and Ivs-2-654 groups were lower than those in control group(P<0.05),while RBC,RDW-CV and RDW-SD were higher than those in control group,the difference was statistically significant.Conclusion The most common genotype in thalassemia were-α3.7/αα,--SEA/αα,-α4.2/αα,CD17,CD41-42 and Ivs-2-654 in Changshou District,Chongqing.The parameters of MCV,MCHC,MCH,Hb,RBC,RDW-CV and RDW-SD have important clinical significance for the screening of thalassemia.

Objective To investigate the expression of miR-27a in colorectal cancer cell,and to analyze the effect of its targeted regulation of(Secreted Frizzled-Related Protein,SFRP1)on the biological behavior of colorectal cancer cells.Methods Real-time fluorescent quantitative PCR(qRT-PCR)was employed to examine the expres-sion of miR-27a and SFRP1 mRNA in colorectal cancer tissues and adjacent normal tissues.Western blot was used to detect the expression of SFRP1 protein in colorectal cancer tissues and adjacent normal tissues.TargetScan soft-ware and dual luciferase reporter gene test were used to detect the targeted regulation of miR-27a on SFRP1.HCT116 cells were transfected with miR-27a mimic,miR-27a inhibitor and negtive control(NC).The expression of miR-27a and SFRP1 mRNA in each group was determined by qRT-PCR.MTT colorimetry was performed to eval-uate the proliferation of each group cells.Transwell assay was used to evaluate the cell invasion and migration abili-ty.Meanwhile,the protein expression levels of SFRP1,key factors Wnt4 and β-catenin in the Wnt/β-catenin sig-naling pathway were determined by Western blot.Results Compared with adjacent normal tissues,miR-27a was highly expressed in colorectal cancer tissues,while SFRP1 was low expressed in colorectal cancer tissues(P<0.05).TargetScan software and dual luciferase reporter gene test showed that miR-27a targeted SFRP1.Compared with NC group,the expression of miR-27a of miR-27a mimic group increased,the proliferation,invasion and mi-gration ability enhanced,the expression of SFRP1 protein decreased,while Wnt4 and β-catenin protein expression increased(P<0.05).Compared with miR-27a mimic group,the expression of miR-27a of miR-27a inhibitor group decreased,the proliferation,invasion and migration ability reduced,the expression of SFRP1 protein in-creased,while Wnt4 and β-catenin protein expression decreased(P<0.05).Conclusion miR-27a can target SFRP1,inhibit the proliferation,invasion and migration of colorectal cancer cells,mainly by up-regulating SFRP1 and blocking the downstream Wnt/β-catenin signaling pathway,which provides a new direction for clinical treat-ment.

Objective:To explore the feasibility of using the large-scale language model ChatGPT to focus on research hotspots in the field of clinical medical education management,aiming to accelerate the scientific research process in this field.Methods:First,six key topics in the field were selected,and ChatGPT was guided to automatically generate the five most urgent or important research hotspots in each topic through questioning.Then,six clinical medical education managers were organized to use the five-point Likert scale to evaluate the research hotspots generated by ChatGPT from five dimensions,including pertinence,humanity,dialectics,expansion,and originality.Finally,the evaluation results were analyzed from multiple perspectives based on descriptive statistics,score similarity,and indicator correlation.Results:The research hotspots generated by ChatGPT performed excellently in terms of topic specificity,and were also satisfactory in terms of humanistic,dialectical,and expansive aspects,but performed mediocrely in terms of originality.Conclusion:ChatGPT can serve as an auxiliary tool to focus on research hotspots in clinical medical education management,but more efforts are still needed to enhance the originality of the research hotspots it generates.However,when using ChatGPT to focus on research hotspots,there are a series of ethical risks,including false and abusive data,discrimination and bias in algorithms,as well as academic dishonesty and misconduct.From the technical perspective,researchers can integrate the focused results of multiple large-scale language models,and utilize data and algorithm diversity to avoid ethical risks.From the application perspective,individual identification,group argumentation,and other means can be utilized,and carefully examined with critical thinking to avoid ethical risks.