ObjectiveThis study aimed to evaluate the clinical efficacy of Ruyi Zhenbaowan（RYZBW）in the treatment of initial and early knee osteoarthritis （KOA） through a prospective multicenter，randomized，double-blind，and placebo-parallel controlled trial. MethodFrom October 13^th， 2021 to December 25^th， 2021， 240 KOA subjects meeting the acceptance criteria were enrolled in 15 sub-centers including Wangjing Hospital， Chinese Academy of Chinese Medical Sciences， and they were randomly divided into observation group and control group， with 120 cases in each group. The intervention measures for the observation group were RYZBW + health education， and the intervention measures for the control group were RYZBW placebo + health education. The intervention period in both groups was four weeks， and they were followed up for four weeks after the intervention. The primary outcome measure was the total score of Western Ontario and McMaster University Osteoarthritis Index score （WOMAC score）， and the secondary outcome measures were the response rate of visual scale （VAS） pain score， WOMAC sub item scores （joint pain， joint stiffness， and joint function）， quality of life （SF-12） score， and traditional Chinese medicine （TCM） syndrome score. Result（1） Efficacy evaluation. The marginal model results showed that the observation group was better than the control group in improving the WOMAC total score and WOMAC pain score in the treatment of KOA with RYZBW， and the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in improving VAS score response rate， WOMAC function score， WOMAC stiffness score， SF12-PCS （quality of life-physical health） score， SF12-MCS （quality of life-mental health） score， and TCM syndrome score. （2） Subgroup analysis. ① In terms of VAS score response rate， the response rate of the observation group was higher than that of the control group for subjects with baseline VAS score of （4， 5］， and the difference was statistically significant （P<0.05）. ② In terms of TCM syndrome score， for subjects aged ［56， 60］ and ［61， 65］， the decrease in total TCM syndrome score in the observation group was better than that in the control group， and the difference was statistically significant （P<0.05）. ConclusionTibetan medicine RYZBW has good clinical efficacy in improving WOMAC total score， VAS score response rate， WOMAC pain score， WOMAC function score， and TCM syndrome score for patients with initial and early KOA， which can fill the lack of Tibetan medicine RYZBW in the treatment of KOA and make a demonstration study for the inheritance and development of ethnic medicine.

Purpose/Significance To explore the changes,challenges,key application scenarios and future development directions of generative artificial intelligence(AI)represented by ChatGPT in the field of hospital management,and to provide references for the ap-plication of AI natural language processing(NLP)technology in the field of hospital management in China.Method/Process Through literature review and analysis,the changes and challenges brought about by the rapid development of generative AI in the field of hospital management are sorted out,its key application scenarios and future development directions in the field of hospital management are empha-sized and explored.Result/Conclusion AI has broad application prospects in the field of hospital management,and it should focus on exploring its practical application scenarios and strategic directions to provide reference and guidance for promoting the high-quality de-velopment of public hospitals.

Objective Medical tangle hearing is an important component of medical malpractice appraisal.By reviewing and analyzing the various conference formats and collaboration models among clinical experts,this study aims to improve the quality of opinion statements and provide support for the formation of medical malpractice judicial appraisal opinions.Methods A total of 185 cases of medical malpractice appraisal were collected from 2019 to 2023 at the Center for Forensic Science,Shanghai Medical College,Fudan University.A retrospective analysis was conducted on the proportion of expert opinions present and accepted in court,which were made with various conference formats and clinical expert attendance,in order to evaluate the relevant factors that could improve the conference quality.Results The effects of various conference formats were similar,and with the support of clinical medical experts,the overall appearance rate was low and the acceptance rate was high.Conclusion Both on-site meetings and remote video conferences can ensure a high quality of opinion presentation and the scientificity and impartiality of appraisal opinions,effectively alleviate doctor-patient conflicts,and provide effective buffering for the subsequent judicial trials or mediation.The key lies in the appraiser's full understanding of medical malpractice cases and the collaborative support of clinical medical experts.

Objective To analyze the epidemiological characteristics of occupational hand-arm vibration disease (OHAVD) in Guangdong Province from 2006 to 2022. Methods The data of newly reported OHAVD cases and suspected occupational disease cases in Guangdong Province from 2006 to 2022 was collected from the Report Card of Occupational Diseases and Report Card of Suspected Occupational Diseases using Occupational Diseases and Health Hazard Factors Monitoring Information System under China Disease Prevention and Control Information System. Epidemiological characteristics of the newly reported OHAVD cases and related suspected occupational disease reports were analyzed. Results A total of 660 newly reported OHAVD cases were reported in Guangdong Province from 2006 to 2022. The number of cases showed a periodic fluctuating trend over the years. Males accounted for 98.64% of the newly reported OHAVD cases with a median age of 38 years and a median hand-transmitted vibration exposure period of 8.7 years. These cases were predominantly distributed in the Pearl River Delta region, including Zhongshan City, Dongguan City, Guangzhou City, Shenzhen City and Foshan City, accounting for 99.25%. The manufacturing enterprises had 98.79% of the cases, investment enterprises of Hong Kong, Macao and Taiwan merchants of China had 83.18% of the cases, and large- and medium-sized enterprises had 92.73% of the cases. The 660 cases were distributed in 440 enterprises, but there were some characteristics of group outbreaks. There were 20 enterprises (4.55% of the total number of enterprises) had more than three cases involving 219 cases (33.18%). There were five enterprises which had more than 10 cases and the cases number ranged from 12 to 56. Among 382 newly reported OHAVD cases from 2014 to 2022, 44.24% were identified as suspected occupational diseases before diagnosis, of which 59.76% (101/169) were determined by occupational health inspection institutions. Conclusion Newly reported OHAVD cases in Guangdong Province were aggregated in terms of regional distribution, industry, enterprise ownership, and enterprise scale, with a risk of group outbreaks. It is suggested to enhance the OHAVD prevention and control in male workers exposed to hand-transmitted vibrations in the Pearl River Delta's manufacturing enterprises.

Objective To investigate the effects of lowdose ionizing radiation (LDIR) on oxidative stress and damage repair in human bronchial epithelial (HBE) cells. Methods HBE cells were divided into 0, 50, 100, and 200 mGy groups, and cultured for 24 and 48 h after X-ray irradiation, respectively. The cell viability, levels of glutathione (GSH), malondialdehyde (MDA), and 8-hydroxy-2’-deoxyguanosine (8-OHdG), and transcriptional levels of DNA damage repair genes PPP2R2D and TP53 were measured. Results At 24 h after irradiation, there was no significant difference in the cell viability between the dose groups and the control group (P > 0.05); all dose groups had significantly increased MDA level, dose-dependently decreased GSH level, dose-dependently increased 8-OHdG level, and significantly increased mRNA level of PPP2R2D gene (all P < 0.05); the mRNA expression level of TP53 gene was significantly increased in the 50 mGy group (P < 0.05). At 48 h after irradiation, there were the highest cell viability, significantly decreased MDA and 8-OHdG levels, and significantly increased mRNA expression levels of PPP2R2D and TP53 genes in the 50 mGy group compared with the control group (all P < 0.05); the GSH level in the 100 mGy group was significantly increased (P < 0.05). Conclusion LDIR, especially radiation at 50 mGy, can affect the oxidative-antioxidant level in HBE cells and the transcript-level differential expression of DNA damage repair genes.

ObjectiveTaking the rat model of spleen-stomach damp-heat syndrome（SSDHS） as the research object， this study aimed to investigate the potential biomarkers of SSDHS and the related metabolic pathways based on urine metabolomics， and tried to reveal the essence of SSDHS at the level of endogenous small molecular metabolites. MethodSixteen SD rats were randomly divided into normal and model groups. The normal group was fed normal chow and the model group was fed with 200 g·L^-1 honey water daily， and lard and Chinese Baijiu alternately on alternate days for 17 days. The SSDHS model rats were exposed to external dampness-heat environment with temperature at 30-34 ℃， relative humidity of 95% for 2 h at the same time every day from the 10^th day for 7 d. Then， the model was evaluated by observing the general conditions of the rats， measuring the contents of motilin（MTL） and gastrin（GT） in plasma by enzyme-linked immunosorbent assay（ELISA）， and examining the histopathology of gastronitestinal tissues. In additon， the urine metabolomics analysis was performed by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS）， and the detection conditions was as follows：ACQUITY™ UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm）， mobile phase of 0.1% formic acid aqueous solution（A）-0.1% formic acid acetonitrile solution（B） for gradient elution （0-3 min， 1%-18%B； 3-8 min， 18%-40%B； 8-10 min， 40%-100%B）， the flow rate of 0.4 mL·min^-1， electrospray ionization（ESI） in positive and negative ion modes， scanning range of m/z 50-1 000. The univariate and multivariate statistical analysis were constructed for screening inter-group differential ions， the element composition was calculated according to the precise relative molecular weight， and ion information was matched with databases such as Human Metabolome Database（HMDB） to identify biomarkers. Kyoto Encyclopedia of Genes and Genomes（KEGG） database was used to obtain the biological information of metabolites， and their associated metabolic pathways were analyzed by MetaboAnalyst 5.0. ResultCompared with the normal group， the rectal temperature of the model group increased significantly（P<0.01）， the levels of plasma MTL and GT decreased significantly（P<0.05， P<0.01）， and pathological changes such as bleeding， congestion and inflammatory infiltration in the gastric and colonic tissues. A total of 25 differential metabolites such as L-histidine， citric acid and isocitric acid were found to be the potential biomarker of SSDHS by urine metabolomics， 13 of which were phase Ⅱ metabolites of endogenous substances（glucuronic acid conjugates， sulfuric acid conjugates and acetyl conjugates）， involving the metabolic pathways of histidine metabolism， tricarboxylic acid cycle， glyoxylate and dicarboxylate metabolism. ConclusionSSDHS primarily causes disorders of histidine metabolism， tricarboxylic acid cycle， glyoxylate and dicarboxylate metabolism， as well as the imbalance of the activation/inactivation of endogenous metabolites， which may involve the immune response， material and energy metabolism， inflammatory response and intestinal flora， and may provide a basis for the establishment and application of SSDHS model.

Background Radiation-induced liver damage is a major complication for primary liver cancer and other upper abdominal tumors during radiation therapy. The early biological effects of radiation-induced liver damage at different doses of radiation and its mechanisms of action have not yet been elucidated. Objective To establish X-ray-induced radioactive mouse liver damage model and explore the level of oxidative stress and its correlation with nuclear factor-κB (NF-κB) and transforming growth factor-β1 (TGF-β1). Methods A total of 24 male C57BL/6J mice aged 6 weeks were randomly divided into 4 groups (control, 0.8 Gy, 1.6 Gy, and 4 Gy), with 6 mice in each group. X-rays irradiated the whole body of mice singly in each dose group. At 24 h after radiation, histopathological changes in mouse liver were evaluated; peripheral blood cell count, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, as well as liver tissue superoxide dismutase (SOD) activity, malondialdehyde (MDA) level, reduced glutathione (GSH) level, and 8-hydroxy-2′-deoxyguanosine (8-OHdG) level were measured; real-time fluorescence quantitative PCR was used to detect liver tissue NF-κB p65 and TGF-β1 mRNA expression levels; the correlations of oxidative stress indicators with NF-κB p65 and TGF-β1 mRNA expression levels were analyzed by Pearson correlation. Results Compared with the control group, at 24 h after different doses of X-ray radiation, early injury-related histopathological changes were observed in liver, and the serum levels of AST and ALT were significantly increased in the 4 Gy group (P<0.05); the numbers of peripheral blood leukocytes and lymphocytes were decreased in the radiation exposure groups (P<0.05), showing a decreasing trend with increasing radiation doses; the levels of liver oxidative stress indicators (MDA, SOD, and GSH) in exposed mice were significantly increased (P<0.05), showing an increasing trend with increasing radiation doses. The liver 8-OHdG were significantly increased in the 1.6 Gy and 4 Gy groups compared with the control and the 0.8 Gy groups, respectively (P<0.05). The NF-κB p65 and TGF-β1 mRNA expression levels in the liver of mice were significantly increased in the 1.6 Gy and 4 Gy groups compared with the control group (P<0.05). The TGF-β1 mRNA expression level also exhibited an increasing trend with increasing radiation doses. The results of correlation analysis showed that the levels of MDA, SOD, GSH, and 8-OHdG in liver tissues were significantly and positively correlated with the expression levels of NF-κB p65 and TGF-β1 mRNA (P<0.05). Conclusion X-rays of various doses can affect the degree of liver injury, peripheral blood cell count, serum levels of AST and ALT, and liver oxidative stress levels in mice. The level of oxidative stress induced by X-ray is positively correlated with NF-κB and TGF-β1 in liver tissues, and it may participate in the process of radiation-induced liver injury.

Objective:To explore the effect of case management of chronic obstructive pulmonary disease (COPD) in the nurse-led clinics.Methods:A total of 50 patients with COPD who met the selection criteria in the outpatient department of the respiratory department of Shantou Central Hospital were enrolled from March 2019 to March 2020. Case management was carried out by specialist nurses in the outpatient department. Body Mass Index (BMI), the forced expiratory volume in one second/predicted value ratio (FEV 1%pred), modified British medical research council (mMRC), 6-min walking distance (6MWD), COPD assessment test (CAT), and St.George Respiratory Questionnaire (SGRQ), basic activities of daily living (BADL) were compared before and after 6 months′ case management. The difference of medication compliance after case management was also analyzed. Results:There were statistically significant differences in the mMRC[(1.9±1.2) vs (1.4±1.1) points], 6MWD[(238.1±84.9) vs (284.1±113.8) m] and CAT scores [(19.7±6.6) vs (17.1±5.9) points], which suggested the improvement of dyspnea, self-conscious symptoms and exercise performance in these patients (all P<0.05). The BADL scores [(87.8±5.4) vs (90.00±7.5) points] and the total score of SGRQ [(48.0±7.3) vs (45.0±6.9) points] were significantly different (both P<0.01). These indicators were improved after the implementation of case management. Patients were followed up for 1 month, 3 months and 6 months, and the improvement of medication compliance score was statistically significant [(7.1±0.8) vs (7.4±0.8) vs (7.7±0.5) points] ( P<0.01). Conclusion:The implementation of respiratory nursing clinic can effectively manage COPD patients, improve medication compliance of patients, so as to improve the degree of dyspnea, self-conscious symptoms, self-care ability and exercise endurance of patients.

Objective:To analyze the prevalence of different genotypes of wild measles virus in Fujian province from 2014 to 2019.Methods:The information of suspected measles cases and the throat swab specimens of the cases in Fujian province from 2014 to 2019 were collected. Reverse transcription-polymerase chain reaction was applied to amplify the 450 nucleotides of the 3-terminal of the nucleoprotein gene. Phylogenetic tree was constructed to identify and analyze the target sequence.Results:A total of 1 102 suspected measles cases were reported in Fujian province from 2014 to 2019, with an annual incidence rate of 0.47/100 000. Totally 884 throat swabs were tested in the laboratory, and 179 nucleotide sequences were obtained except vaccine strain. Sequence analysis showed that 110 measles genotypes were H1, 43 were B3 and 26 were D8. Nucleotide homology analysis showed that the H1a genotype measles virus in Fujian province distributed in two branches, divided into nine different sequence variants. Some of the variants were highly homologous (99.8%-100.0%) with the measles strains in other regions and countries. There were six different sequence variants of B3 genotype measles virus in Fujian province. The nucleotide homology between the B3 genotype measles virus in Fujian province and the domestic and foreign prevalent B3 strains was 98.4%-100.0%. The D8 genotype measles strain in Fujian province had five different sequence variants, some of which were highly homologous with the strains from Vietnam, Japan and Thailand.Conclusions:Three different genotypes of measles viruses (H1, B3 and D8) prevailed in Fujian province from 2014 to 2019, among which H1 genotype was still the local endemic genotype, while B3 and D8 genotypes were imported genotypes in Fujian province. The result indicated that although the local cases of measles were less in Fujian province in recent years, the risk of imported cases from abroad was increasing, and the surveillance of imported cases from abroad should be strengthened.

Objective:To analyze the epidemiological features of geriatric humeral surgical neck fractures from 2010 through 2019 in The Third Hospital of Hebei Medical University.Methods:A retrospective study was conducted of the data of the inpatients aged ≥60 years who had been treated for humeral surgical neck fractures in The Third Hospital of Hebei Medical University from 2010 through 2019. The patients were divided into 2 groups by the year of admission: the former five-year group (group A from January 1, 2010 to December 31, 2014) and latter five-year group (group B from January 1, 2015 to December 31, 2019). The data of the patients were compared between the 2 groups to find the epidemiological characteristics and trends of the humeral surgical neck fractures in the 10-year period.Results:A total of 312 geriatric humeral surgical neck fractures were included, accounting for 1.2%(312/25, 764) of the upper limb fractures and 0.4% (312/88, 886) of all the fractures in the same period. There were 64 males and 248 females, giving a male/female ratio of 0.26∶1. Their ages ranged from 60 to 93 years. The peak age of the fractures was from 60 to 69 years for both males and females. Falls and indoor activity injuries accounted for the largest proportion (71.2%, 222/312). The common fracture types were 11-A2 and 11-A3. The proportion of overweight and obese patients by the body mass index (BMI) was the largest (58.7%, 183/312). There were no statistically significant differences between groups A and B in male/female ratio (0.37:1 versus 0.22:1) or in proportion of peak age patients [42.7% (38/89) versus 55.2% (123/223)] ( P>0.05). There were statistically significant differences between the 2 groups in injury causes, fracture types and BMI distribution ( P<0.05). Conclusions:The geriatric humeral surgical neck fractures accounted for 1.2% of the upper limb fractures and 0.4% of all the fractures in the same period. There were more female patients than male ones. Falls and indoor activity injuries were the most common causes. The proportions of complex fractures and overweight and obese patients increased.