OBJECTIVE To study the extraction technology of Sophora flavescens-Phellodendron chinense drug pair and provide a reference for the development of new drugs for the treatment of anorectal diseases. METHODS Using the contents of total alkaloids of S. flavescens （matrine+oxymatrine）， berberine hydrochloride and total flavonoid， and extract yield as evaluation indicators， analytic hierarchy process-entropy weight method was used to calculate the weight coefficient of each indicator， and was combined with Box-Behnken design-response surface method to study the extraction technology of S. flavescens-P. chinense drug pair and verify it. RESULTS The optimal extraction technology of S. flavescens-P. chinense drug pair was immersed in 12-fold amount of 58% ethanol for 30 minutes and extracted twice， each time for 120 minutes. The relative error between the verification experimental results and the predicted value was 1.88%. CONCLUSIONS The obtained extraction technology is stable and feasible and can provide reference for the application of S. flavescens-P. chinense drug pair and development of new drugs.

Objective To investigate the expression and clinical significance of miR-34c and miR-29b in peripheral blood of patients with sensorineural hearing loss.Methods 140 patients with neurological deafness admitted to our hospital from June 2020 to June 2023 were included in the study group,and 40 healthy subjects were included in the control group during the same period.SNHL patients were categorized into 63 cases in the mildly deaf group,42 cases in the moderately deaf group,and 35 cases in the severely deaf group according to their hear-ing impairment.The expressions of miR-34c and miR-29b were detected by qRT-PCR,and VEGF,oxidative stress(TAC,SOD,MDA),NO and Cx26 were detected.Correlation analysis was performed by Pearson test,independent risk factors for SNHL severity were calculated by logistics regression algorithm,and the predictive value of miR-34c and miR-29b on the severity of SNHL patients was evaluated by ROC curve.Results Comparing the levels of NO,TAC,SOD,and Cx26 among the four groups,severe deafness groupmoderate deafness group>mild deafness group>control group(P<0.05).Comparison of miR-34c mRNA and miR-29b mRNA expression levels among the four groups,severe deafness group>moderate deafness group>mild deafness group>control group(P<0.05).Pearson's test showed that SNHL patients'peripheral blood miR-34c and miR-29b were positively correlated with VEGF and MDA,and were negatively correlated with NO,TAC,SOD and Cx26(P<0.05).negative correlation(P<0.05).Multifactorial logistic regression analysis showed that VEGF,MDA,NO,Cx26,TAC,SOD,miR-34c,miR-29b were independent factors affecting the severity of SNHL.Conclusion miR-34c and miR-29b are overexpressed in SNHL patients and can be used as serum markers for predictive assess-ment of disease severity in SNHL patients.

Objective:To study lncRNA MEG3 expression and its relationship with Th17/CD4+T cells in patients with non-small cell lung cancer(NSCLC)with different pleural effusion severity and prognosis.Methods:A total of 104 NSCLC malignant pleural effusion patients admitted to Quanzhou First Hospital Affiliated to Fujian Medical University from January 2020 to December 2022 were selected as research subjects,and divided into three groups based on amount of pleural effusion,including small amount of pleural effusion group(35 cases),moderate amount of pleural effusion group(42 cases)and large amount of pleural effusion group(27 cases).According to actual development and prognosis of patient's disease,they were divided into good prognosis group(29 cases without recurrence and metastasis)and poor prognosis group(75 cases with recurrence and metastasis).Another 60 patients with benign pleural effusion due to pneumonia who were treated in Quanzhou First Hospital Affiliated to Fujian Medical University at same time were selected as control group.MEG3 expression in pleural effusion of two groups was detected by real-time fluorescent quantita-tive PCR,and peripheral venous blood of subjects was collected.Th17 cell and CD4+T cell ratios of peripheral blood were detected by flow cytometry,and Th17/CD4+T was calculated.lncRNA MEG3 and peripheral blood Th17 and CD4+T levels in each group of patients compared.Logistic regression analysis was used to analyze pleural effusion and prognostic factors in NSCLC.Results:lncRNA MEG3 expression and CD4+T percentage in pleural effusion in NSCLC group were lower than control group,while Th17 percentage and Th17/CD4+T were higher than control group(P<0.05).lncRNA MEG3 expression and CD4+T percentage in large pleural effusion group were lower than small and moderate pleural effusion groups.lncRNA MEG3 expression and CD4+T percentage in modarate pleural effusion group were lower than small pleural effusion group,while Th17 percentage and Th17/CD4+T in large pleural effusion group were higher than small and moderate pleural effusion groups.Th17/CD4+T was higher in small amount pleural effusion group(P<0.05).lncRNA MEG3 expression and CD4+T percentage in poor prognosis group were lower than those in good prognosis group,while Th17 percentage and Th17/CD4+T were higher than good prognosis group(P<0.05).Logistic regression analysis showed that lncRNA MEG3 was a protective factor for NSCLC pleural effusion,and Th17/CD4+T was a risk factor(P<0.05),lncRNA MEG3 was a protective factor of NSCLC prognosis,and Th17/CD4+T was a risk factor(P<0.05).Conclusion:lncRNA MEG3 expression and Th17/CD4+T in NSCLC patients with different pleural effusion severity and prognosis is not same.lncRNA MEG3 is a risk factor for NSCLC pleural effusion and prognosis,while Th17/CD4+T is a risk factor,which can be used as an effective biomarker for pleural effusion severity and progno-sis diagnosis.

Paperless management of medical records is of great significance in promoting refined hospital management. Driven by national policies and the development of information technology in medical institutions, paperless medical records have become an inevitable trend in the development of medical records. However, at present, there were still a large number of medical record data in China that cannot be digitized or directly uploaded to hospital electronic medical record systems. Since 2019, the First Hospital of Jiaxing has launched a paperless medical record construction project and established a paperless medical record management system, forming a closed-loop management system for the entire process of medical record collection, archiving, storage, management, and utilization. By the end of 2021, paperless of medical records in all departments had been achieved, electronic signatures had been fully implemented, and paperless versions of reports of standalone equipment, high-value consumables barcodes, surgical anesthesia related documents, and outsourced inspection reports had been achieved, with a paperless rate of 98.5%. Through paperless management of medical records, the supervision of medical record quality and medical quality has been strengthened, operating costs have been reduced and work efficiency has been improved. At the same time, this has provided convenience for medical personnel to access medical record information and applicate of the data, and has effectively improved the hospital′s level of refined management. It can provide reference for paperless management of medical records in other medical institutions.

ObjectiveTo study the constituents migrating to blood of Qingyan formula by serum pharmacochemistry， and investigate the binding energy between these constituents and estrogen receptor （ER）， so as to confirm the pharmacodynamic material basis of Qingyan formula in rats. MethodUltra-high performance liquid chromatography-quadrupole electrostatic field-orbital trap high resolution mass spectrometry （UPLC-Q-Orbitrap-MS） was used to determine the constituents migrating to blood of Qingyan formula in rats by comparing the fingerprint differences of 70% ethanol extract of Qingyan formula， 70% ethanol extract of each single drug in this formula， blank serum and serum after administration of 70% ethanol extract of Qingyan formula， according to the retention time， relative molecular weight and the primary and secondary ion fragments provided by MS. Mobile phase was 0.1% formic acid aqueous solution （A）-acetonitrile（B） for gradient elution （0-5 min， 2%-20%B； 5-10 min； 20%-50%B； 10-15 min， 50%-80%B； 15-25 min， 80%-95%B； 25-26 min， 95%-2%B； 26-30 min， 2%B）， the flow rate was 0.3 mL·min^-1 and the injection volume was 5 μL， electrospray ionization was used with detection range of m/z 150-2 000， positive and negative ion scanning modes. Molecular docking technology was used to characterize the binding energy of constituents migrating to blood with ERα and ERβ， and to confirm the material basis of this formula. ResultAfter oral administration of Qingyan formula， 30 components were detected in serum， of which 9 were prototype components and 21 were metabolites. Nine prototype components were identified as monotropein， asperuloside， verbascoside， β-ecdysone， allantoin， deacetyl asperuloside acid， echinacoside， betaine and caffeic acid， 21 metabolites mainly included organic acids， amino acids， cholines and so on. The binding energies of the above 9 prototype components with ERα were -6.7， -8.9， -6.0， -5.7， -5.3， -4.9， -7.3， -3.3， -6.3 kcal·mol^-1 （1 kcal≈4 184 J）， and the binding energies of them with ERβ were -6.6， -7.2， -7.7， 8.0， -7.4， -5.5， -6.9， -3.6， -6.4 kcal·mol^-1， respectively. ConclusionThese nine prototype components into blood are the active ingredients of Qingyan formula that play estrogen-like role in the body， which can provide experimental basis for the formulation of quality standards and subsequent research and development of Qingyan formula.

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Objective:To explore the effect of grid management combined with guided and driven teaching mode in operation teaching of nursing interns.Methods:From February 2020 to January 2022, 300 nursing interns from the 2020 and 2021 sessions of the Wuxi Second People's Hospital were selected as the research subject by convenience sampling. According to the method of random number table, the nursing interns from February 2020 to January 2021 were set as the control group, and the nursing interns from February 2021 to January 2022 were set as the experimental group, with 150 in each group. The control group adopted the traditional teaching, while the experimental group carried out the grid management combined with guided and driven teaching mode on the basis of the control group. The results, self-study ability, learning enthusiasm, teaching satisfaction, practice satisfaction, and the incidence of sharp tool puncture during the practice were compared between the two groups before and after the practice.Results:After the experiment, the scores of theoretical and operational skills, learning enthusiasm and self-study ability, practice satisfaction of nursing interns in the experimental group were higher than those in the control group, and the incidence of sharp tool puncture was lower than that in the control group, with statistical differences ( P<0.05) . Conclusions:Grid management combined with guided and driven teaching mode can improve the interns' theoretical mastery and clinical operation proficiency, enhance their self-study ability, fully stimulate their learning enthusiasm, and reduce the incidence of clinical accidental injuries, which is worthy of promotion and application.

Objective:To analyze the correlation factors between peripapillary duodenal diverticulum (PDD) and choledochectasia by CT scan.Methods:The clinical data of 220 patients with duodenal diverticulum detected by multi-slice spiral CT scan and confirmed by gastrointestinal angiography or endoscopic retrograde cholangiopancreatography (ERCP) in Dahua Hospital, Xuhui District of Shanghai City were retrospectively analyzed. The correlation of the PDD, the contact of common bile duct (CBD), length of contact and exudation with choledochectasia in patients with PDD were analyzed.Results:A total of 236 duodenal diverticulum were found in 220 patients. Among them, there were 152 PDD, 41 diverticulum located superior to the duodenal papilla, 28 diverticulum located inferior to the duodenal papilla, 3 diverticulum located lateral to the duodenal papilla, and 12 diverticulumlocated in the horizontal portion. The incidence of choledochectasia in patients with PDD contacted with CBD was significantly higher than that in patients with PDD not contacted with CBD: 59.35% (73/123) vs. 37.93% (11/29), and there was statistical difference ( P<0.05); the incidence of choledochectasia in patients with contact length of PDD and CBD ≥1.5 cm was significantly higher than that in patients without contact of PDD and CBD and patients with contact length of PDD and CBD <1.5 cm: 82.43% (61/74) vs. 24.49% (12/49) and 37.93% (11/29), and there was statistical difference ( P<0.05); the incidence of choledochectasia in PDD patients with exudation was significantly higher than that in PDD patients without exudation: 10/11 vs. 52.48% (74/141), and there was statistical difference ( P<0.05). Conclusions:The patients with contact length of PDD and CBD ≥1.5 cm and patients with PDD combined with exudation could be prone to choledochectasia.

Dysglycemia is independently associated with the mortality of critically ill patients. Therefore, the management of blood glucose plays an important role in comprehensive therapy. It is suggested that the same target value of blood glucose (7.8-10.0 mmol/L) should not be set for all critically ill patients. Instead, it should be individually set based on the causes of the patient's admission and the status of blood glucose before admission. For this reason, there is an urgent need for a convenient protocol and method to regulate the dosage of insulin. The first hospital of Jiaxing, collaborating with information engineers, developed a modified eProtocol-insulin for domestic population with mathematical modeling and developed an Application Software (APP), which is convenient for clinical use. This is the first eProtocol-insulin and smart device APP for critically ill patients in China.

Objective To investigate the prevalence of restless legs syndrome (RLS) in peritoneal dialysis patients and analyze the related risk factors.Methods This study was a cross-sectional study.The patients receiving maintenance peritoneal dialysis from January 2017 to December 2017 in the Peritoneal Dialysis Center of the Second Hospital Affiliated to Soochow University were selected as the study subjects.RLS was screened for peritoneal dialysis patients by epidemiological field investigation based on the RLS diagnostic criteria of the International Restless Leg Syndrome Research Group in 2014.Clinical data and laboratory examinations of selected patients were collected and the differences of clinical indicators between RLS and non-RLS patients were compared.The risk factors related to RLS were analyzed by logistic regression.Results Seventy-six cases of RLS were screened out from 396 PD patients.The prevalence of RLS was 19.2％.Compared with non-RLS group,RLS group patients had longer dialysis age,less 24 hours urine volume,and elevated blood intact Parathormone (iPTH) and alkaline phosphatase (AKP) (all P ＜ 0.05).There was no significant difference in primary disease ratio,sex,age,body mass index,blood pressure,hemoglobin,creatinine,urea nitrogen,uric acid,ferritin,serum iron,transferrin saturation,blood calcium,blood phosphorus,total cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,eGFR,Kt/V,Ccr between RLS and non-RLS group patients (all P ＞ 0.05).Multivariate logistic regression analysis showed that long dialysis age (OR=1.010,95％CI 1.001-1.018,P=0.022) and high blood AKP (OR=1.005,95％CI 1.001-1.010,P=0.021) were independent risk factors for RLS in peritoneal dialysis patients (both P ＜ 0.05).Conclusions The prevalence of RLS is high in peritoneal dialysis patients.Long dialysis age and high blood AKP are independent risk factors for RLS.