ObjectiveTo establish a model that can quickly identify the aroma components in different parts of Nardostachys jatamansi， so as to provide a quality control basis for the market circulation and clinical use of N. jatamansi. MethodsHeadspace solid-phase microextraction-gas chromatography-mass spectrometry（HS-SPME-GC-MS） combined with Smart aroma database and National Institute of Standards and Technology（NIST） database were used to characterize the aroma components in different parts of N. jatamansi， and the aroma components were quantified according to relative response factor（RRF） and three internal standards， and the markers of aroma differences in different parts of N. jatamansi were identified by orthogonal partial least squares-discriminant analysis（OPLS-DA） and cluster thermal analysis based on variable importance in the projection（VIP） value >1 and P<0.01. The odor data of different parts of N. jatamansi were collected by Heracles Ⅱ Neo ultra-fast gas phase electronic nose， and the correlation between compound types of aroma components collected by the ultra-fast gas phase electronic nose and the detection results of HS-SPME-GC-MS was investigated by drawing odor fingerprints and odor response radargrams. Chromatographic peak information with distinguishing ability≥0.700 and peak area≥200 was selected as sensor data， and the rapid identification model of different parts of N. jatamansi was established by principal component analysis（PCA）， discriminant factor alysis（DFA）， soft independent modeling of class analogies（SIMCA） and statistical quality control analysis（SQCA）. ResultsThe HS-SPME-GC-MS results showed that there were 28 common components in the underground and aboveground parts of N. jatamansi， of which 22 could be quantified and 12 significantly different components were screened out. Among these 12 components， the contents of five components（ethyl isovalerate， 2-pentylfuran， benzyl alcohol， nonanal and glacial acetic acid，） in the aboveground part of N. jatamansi were significantly higher than those in the underground part（P<0.01）， the contents of β-ionone， patchouli alcohol， α-caryophyllene， linalyl butyrate， valencene， 1，8-cineole and p-cymene in the underground part of N. jatamansi were significantly higher than those in the aboveground part（P<0.01）. Heracles Ⅱ Neo electronic nose results showed that the PCA discrimination index of the underground and aboveground parts of N. jatamansi was 82， and the contribution rates of the principal component factors were 99.94% and 99.89% when 2 and 3 principal components were extracted， respectively. The contribution rate of the discriminant factor 1 of the DFA model constructed on the basis of PCA was 100%， the validation score of the SIMCA model for discrimination of the two parts was 99， and SQCA could clearly distinguish different parts of N. jatamansi. ConclusionHS-SPME-GC-MS can clarify the differential markers of underground and aboveground parts of N. jatamansi. The four analytical models provided by Heracles Ⅱ Neo electronic nose（PCA， DFA， SIMCA and SQCA） can realize the rapid identification of different parts of N. jatamansi. Combining the two results， it is speculated that terpenes and carboxylic acids may be the main factors contributing to the difference in aroma between the underground and aboveground parts of N. jatamansi.

This article systematically analyzes the historical evolution of the name， origin， quality evaluation， harvesting， processing and other aspects of Picrorhizae Rhizoma by referring to the medical books， prescription books， and other documents of the past dynasties， combined with relevant modern research materials， in order to provide a basis for the development and utilization of famous classical formulas containing this medicinal herb. The research results indicate that Picrorhizae Rhizoma was first recorded in New Revised Materia Medica from the Tang dynasty. Throughout history， Huhuanglian has been used as its official name， and there are also aliases such as Gehu Luze， Jiahuanglian and Hulian. The main source of past dynasties is the the rhizomes of Picrorhiza kurrooa and P. scrophulariiflora. In ancient times， Picrorhizae Rhizoma was mainly imported by foreign traders via Guangzhou and other regions， and also produced in China， mainly in Xizang. In ancient times， it was harvested and dried in early August of the lunar calendar， while in modern times， it is mostly harvested from July to September， with the best quality being those with thick and crispy rhizomes without impurities， and bitter taste. Throughout history， Picrorhizae Rhizoma was collected， washed， sliced， and dried before being used as a raw material for medicine， it has a bitter and cold taste， mainly used to treat bone steaming， hot flashes， infantile chancre fever， and dysentery. There is no significant difference in taste and efficacy between ancient and modern times. Based on the research results， it is recommended that the rhizomes of P. scrophulariiflora in the 2020 edition of Chinese Pharmacopoeia， or the rhizomes of P. kurrooa， can be used in famous classical formulas containing this medicinal herb， which can be processed according to the processing requirements marked by the original formula. For those without clear processing requirements， the dried raw products are used as medicine.

The immunomodulatory， repair， and regeneration-promoting functions of mesenchymal stem cells make them one of the potential treatment methods for liver diseases. At present， viral and non-viral delivery methods have been developed to genetically modify mesenchymal stem cells， and gene modification can promote the survival， homing， and cytokine secretion of mesenchymal stem cells， thereby enhancing the ability of mesenchymal stem cells to treat liver diseases. This article mainly summarizes the research advances in gene-modified mesenchymal stem cells in the treatment of liver diseases， in order to provide new insights and strategies for the clinical treatment of liver diseases.

OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.

Objective:To compare the efficacy of Solution-focused brief therapy (SFBT) and the conventional care in the improvement of the prognosis and mental state of patients with chronic bone infection.Methods:A retrospective cohort study was conducted to analyze the clinical data of 219 patients with chronic bone infection who were admitted to the First Affiliated Hospital of the Army Medical University from January 2018 to February 2019, including 172 males and 47 females, aged 15-65 years [(42.1±3.8)years]. Infection sites were the tibia in 144 patients and the femur in 75 patients. According to the classification of Cierny-Mader bone infection, there were 44 patients with type I (intramedullary bone infection), 57 with type II (superficial bone infection), 79 with type III (local bone infection), and 39 with type IV (diffuse bone infection). The patients were divided into conventional care group (admitted from January to July 2018, n=106) and SFBT group (admitted from August 2018 to February 2019, n=113) according to their admission time. The conventional care group received the conventional care, while the SFBT group underwent SFBT on the basis of the conventional care, with an intervention period of 6 months. The Hospital for Special Surgery (HSS) knee score, 36-item Short Form Health Survey (SF-36) for somatic, emotional, role and social function, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were compared between the two groups before surgery, at discharge and at 6 months after surgery. The rates of satisfaction with the nursing care and bone healing were collected at the last follow-up. Results:All the patients were followed up for 12-36 months [(24.5±6.3)months]. The differences in HSS knee score, SF-36 for somatic, emotional, role, and social function scores, SAS score, and SDS score between the two groups were not statistically significant before surgery ( P>0.05). At discharge, the HSS knee score and SF-36 for somatic, emotional, role, and social function scores of the SFBT group were (68.6±6.9)points, (23.0±1.8)points, (23.2±1.6)points, (23.4±1.5)points, and (23.1±1.8)points respectively, which were all significantly higher than those of the conventional care group [(66.3±7.2)points, (19.7±3.3)points, (20.0±2.7)points, (19.8±3.2)points, and (20.5±2.7)points respectively] ( P<0.05); The SAS and SDS scores in the SFBT group were (40.9±6.2)points and (41.1±6.2)points respectively, which were both significantly lower than those in the conventional care group [(46.4±6.3)points and (47.3±6.4)points] ( P<0.05). At 6 months after surgery, the HSS knee score and SF-36 for somatic, emotional, role, and social function scores in the SFBT group were (81.6±6.7)points, (26.3±1.6)points, (27.9±1.4)points, (26.6±1.4)points, and (27.9±1.6)points respectively, which were all significantly higher than those in the conventional care group [(78.5±7.2)points, (17.4±2.9)points, (18.7±2.5)points, (18.3±3.0)points, and (20.0±2.5)points respectively] ( P<0.05 or 0.01); the SAS and SDS scores in the SFBT group were (32.8±4.8)points and (30.8±5.5)points respectively, which were significantly lower than those in the conventional care group [(44.2±5.5)points and (42.5±6.2)points] ( P<0.05). At the last follow-up in the conventional care group and the SFBT group, the rates of satisfaction with the nursing care were 66.0% (70/106) and 88.5% (100/113) respectively ( P<0.01), and the bone healing rates were 96.2% (102/106) and 94.7% (107/113) respectively ( P>0.05). Conclusion:Compared with the conventional care, SFBT for intervention to patients with chronic bone infection is a safe and effective mental nursing model which can improve the recovery of the function and the quality of the patients′ life, reduce their anxiety and depression, and enhance their satisfaction rate.

Objective:To investigate the prediction of the tumor proliferation antigen(Ki-67) expression status in breast cancer patients based on ultrasound radiomics combined with clinicopathologic features.Methods:Breast cancer patients who underwent 2D ultrasound and Ki-67 examination from January 2018 to February 2022 in Changzhou Second People′s Hospital, Nanjing Medical University were retrospectively analyzed. Among them, 427 patients from Chengzhong campus were randomly divided into training and validation sets in the ratio of 8∶2, and 229 patients from Yanghu campus were used as an independent external test set. Radiomics features were extracted from the region of interest of 2D ultrasound images, and the Mann-Whitney U test, recursive feature elimination, and minimum absolute shrinkage and selection operators were used to perform feature dimensionality reduction and to establish a radiomics score(Rad-score). Subsequently, single/multifactor logistic regression regression analyses were used to construct a joint prediction model based on Rad-score and clinicopathological features. Model performance and utility were assessed using the subject operating characteristic area under the curve (AUC), calibration curve, and decision curve analyses. Results:The AUCs of the joint model for predicting Ki-67 expression status in breast cancer in the training, validation, and test sets were 0.858, 0.797, and 0.802, respectively, which were superior to those of the radiomics (0.772, 0.731, and 0.713) and clinical models (0.738, 0.750, and 0.707). Calibration curve and decision curve analyses indicated that the joint model had good calibration and clinical value.Conclusions:A joint model based on ultrasound radiomics and clinicopathological features can effectively predict the Ki-67 expression status of breast cancer, which is expected to become a non-invasive tool for Ki-67 detection and provide clinicians with an important auxiliary diagnostic and therapeutic decision-making basis.

Objective:To investigate the levels of osteoporosis-related biomarkers in individuals with subclinical hypothyroidism complicated by type 2 diabetes mellitus.Methods:A cross-sectional study. From January 2021 to June 2022, 40 patients with subclinical hypothyroidism, 40 patients with type 2 diabetes, 40 patients with type 2 diabetes complicated with subclinical hypothyroidism, and 40 individuals receiving physical examination in Shanxi Bethune Hospital were selected as subjects in this study. The glucose and lipid metabolism indexes and bone metabolism indexes of the subjects were detected, and the differences and correlations of the metabolic indexes among the groups were analyzed by t-tests, nonparametric tests or correlation analysis. Results:Compared with healthy group, beta C-terminal cross-linked telopeptides of type Ⅰ collagen (β-CTX) level in type 2 diabetes group was higher [(344.60±125.61) vs (227.56±68.33) pg/ml] ( t=-5.176, P<0.001), osteocalcin (OC) and total procollagen type 1 aminoterminal peptide (t-PINP) were both lower [(15.76±4.70) vs (28.02±5.83)ng/ml, (43.49±13.63) vs (59.58±15.80) ng/ml] ( t=10.352, t=4.874, P<0.001). The β-CTX level in type 2 diabetes patients complicated with hypothyroidism was higher than that in patients with simple subclinical hypothyroidism [(380.51±122.22) vs (212.41±44.17) pg/ml] ( t=-8.180 ,P<0.001), but the levels of OC and t-PINP were both lower [(13.67±4.06) vs (26.12±4.55) ng/ml, (38.76±9.53) vs (61.50±12.31) ng/ml] ( t=12.897, P<0.001); but there was no significant difference in the three biomarkers between patients with type 2 diabetes mellitus complicated by subclinical hypothyroidism and those with type 2 diabetes mellitus alone. [β-CTX: (380.51±122.22) vs (344.60±125.61) pg/ml, OC: (13.67±4.06) vs (15.76±4.70) ng/ml, t-PINP: (38.76±9.53) vs (43.49±13.63) ng/ml] ( t=1.296,1.890,-1.799 ,all P>0.05). In the patients with type 2 diabetes mellitus complicated by subclinical hypothyroidism, the β-CTX was positively correlated with fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c)( r=0.293,0.487,all P<0.05), while OC and t-PINP were negatively correlated with FBG and HbA1c ( r=-0.560,-0.502,-0.289,-0.326, P<0.05). Conclusion:Changes of serum osteoporosis-related biomarkers in subclinical hypothyroidism patients with type 2 diabetes indicate the increased risk of osteoporosis in those patients.

BACKGROUND:Studies have shown that cardiomyocyte apoptosis is closely related to cardiac decompensation and the cardiac aging process.Appropriate exercise can alter heart pump function in patients with heart failure as well as attenuate aging-induced cardiomyocyte apoptosis,hypertrophy,and fibrotic damage. OBJECTIVE:To investigate the effects of long-term aerobic exercise on cardiomyocyte apoptosis and the thioredoxin system in aging rats. METHODS:Thirty-six male Sprague-Dawley rats were selected and divided into three age groups:3-month-old young group,9-month-old middle-aged group,and 18-month-old elderly group,with 12 rats in each group.Within each age group,rats were randomly assigned to sedentary and exercise subgroups(n=6 per group).The sedentary groups did not undergo any exercise intervention.The exercise groups were acclimated to a treadmill environment and subsequently subjected to treadmill exercise for 45 minutes per day,at a speed of 15 m/min,5 days per week for 10 weeks in total.At 24 hours after the final intervention,ELISA was employed to measure serum levels of cardiac troponin I and creatine kinase-MB in rats.TUNEL assay was utilized to detect cardiomyocyte apoptosis,while western blot assay was employed to assess the protein expression of Bax,Bcl-2,Caspase 3,thioredoxin-1,thioredoxin-2,thioredoxin reductase-1,thioredoxin reductase-2,thioredoxin-interacting protein,apoptosis signal-regulating kinase 1,and P38 mitogen-activated protein kinase in rat myocardial tissue. RESULTS AND CONCLUSION:Serum levels of cardiac troponin I and creatine kinase-MB in the elderly sedentary group were significantly higher than those in the young and middle-aged sedentary groups and elderly exercise group(P<0.01).Serum levels of cardiac troponin I and creatine kinase-MB in the elderly sedentary group were significantly higher than those in the young and middle-aged exercise groups and elderly exercise group(P<0.01).Positive apoptotic cells in rat myocardial tissue,along with increased protein expression of Bax and Caspase 3,exhibited an age-related upward trend,while Bcl-2 protein expression showed a declining trend.In comparison with the sedentary groups within each age category,the number of apoptotic cardiomyocytes and the expression of Bax and Caspase 3 proteins were reduced to different degrees,and the expression of Bcl-2 protein was increased to different degrees in the corresponding exercise groups.Compared with the young sedentary group,middle-aged sedentary group and elderly exercise group,elderly sedentary rats showed a significant decrease in the expression of myocardial thioredoxin 1,thioredoxin 2,thioredoxin reductase 1,and thioredoxin reductase 2 proteins(P<0.05,P<0.01).The expression of myocardial thioredoxin 1,thioredoxin 2,and thioredoxin reductase 2 proteins was lower in the elderly exercise group than in the young exercise group(P<0.05,P<0.01),while the expression of thioredoxin reductase 1 and thioredoxin reductase 2 proteins was lower in the elderly exercise group than in the middle-aged exercise group(P<0.01).The protein expression of thioredoxin-interacting protein,apoptosis signal-regulating kinase 1,and P38 mitogen-activated protein kinase in rat myocardium was significantly higher in the elderly sedentary group than the young sedentary group,middle-aged sedentary group and elderly exercise group(P<0.01).The protein expression of thioredoxin-interacting protein,apoptosis signal-regulating kinase 1,and P38 mitogen-activated protein kinase in rat myocardium was significantly higher in the elderly exercise group than the young exercise group and middle-aged exercise group(P<0.01).To conclude,aerobic exercise may enhance the anti-apoptotic effects of thioredoxin by down-regulating the expression of thioredoxin-interacting protein in aging rat hearts,leading to the downregulation of apoptosis signal-regulated kinase 1 and P38 mitogen-activated kinase protein,thereby alleviating myocardial cell apoptosis in aging rat hearts.

Objective:To explore the mediating role of positive coping style between social support and post-discharge coping difficulty among mothers of premature infants, so as to provide guidance for medical staff to deeply understand and improve the post-discharge coping difficulty of mothers.Methods:A convenience sampling method was employed to select 310 mothers of premature infants from the neonatal intensive care units of five tertiary level A hospitals in Shandong Province from March to June 2023 as the study population. A cross-sectional survey was conducted using the general information questionnaire, the Social Support Rating Scale, the Simple Coping Style Questionnaire, and the Post-Discharge Coping Difficulty Scale-Parent Form.Results:A total of 280 valid questionnaires were returned, among which the age of mothers was (32.70 ± 5.08) years. The score of social support, positive coping style and post-discharge coping difficulty in mothers of preterm infants was (42.59 ± 7.40), (23.06 ± 6.75) and (3.64 ± 1.74) points respectively. Social support was positively associated with positive coping style ( r=0.404, P<0.01), social support and positive coping style were negatively associated with post-discharge coping difficulty ( r=-0.368, -0.369, both P<0.01). Positive coping style partially mediated the relationship between social support and post-discharge coping difficulty, which accounted for 31.11% of the total effect. Conclusions:Social support can affect post-discharge coping difficulty of mothers of premature infants through positive coping style. Medical staff should pay attention to the enhancement of social support and the cultivation of positive coping style of mothers of premature infants, and take targeted measures to reduce the post-discharge coping difficulty.

Objective:To investigate the effects of Jianpi Yishen Xiezhuo Decoction on residual renal function and immune function in patients with end-stage renal disease undergoing peritoneal dialysis.Methods:Randomized controlled trial study was performed. A total of 102 end-stage renal patients with peritoneal dialysis in the Shehong Traditional Chinese Medicine Hospital from March 2021 to March 2023 were selected as the observation objects, and were divided into 2 groups by random number table method, with 51 cases in each group. The control group was given conventional Western medicine therapy on the basis of peritoneal dialysis, and the observation group was given Jianpi Yishen Xiezhuo Decoction on the basis of peritoneal dialysis. Both groups were treated continuously for 3 months. TCM syndrome score was performed before and after treatment, and serum SCr and BUN levels were detected by automatic biochemical analyzer. The levels of CD3 +, CD4 + and CD8 + were detected by flow cytometry; the ratio of CD4 +/CD8 + was calculated; the levels of IL-2, CXC chemokine ligand 9 (CXCL9) and hypersensitive C-reactive protein (hs-CRP) were detected by ELISA. 24 h urine was collected and 24 h urine protein quantification (24 hUP) was performed by automatic urine routine analyzer. The adverse reactions during treatment were recorded and the clinical efficacy was evaluated. Results:The total effective rate was 92.16% (47/51) in the observation group and 76.47% (39/51) in the control group, with statistical significance ( χ2=4.74, P=0.029). After treatment, fatigue (1.78±0.47 vs. 2.17±0.51, t=4.02), waist and knee weakness (1.90±0.52 vs. 2.29±0.59, t=3.54), lethargy and less food (2.03±0.55 vs. 2.65±0.70, t=4.97), thick-coated tongue (2.26±0.68 vs. 2.98±0.75, t=5.08) and total scores (7.97±2.22 vs. 10.09±2.55, t=4.48) were lower than those in the control group ( P<0.01); serum SCr [(296.12±30.27) mmol/L vs. (326.81±32.43) mmol/L, t=4.94], BUN [(12.19±3.02) mmol/L vs. (16.88±3.64) mmol/L, t=7.08], 24 hUP [(1.22±0.35) g vs. (1.75±0.42) g, t=6.92] were lower than those in the control group ( P<0.01); the level of CD3 + [(54.76±5.21) % vs. (50.03±4.90) %, t=4.72], CD4 + [(56.33±5.09) % vs. (52.18±5.33) %, t=4.02] and CD4 +/CD8 + [(1.98±0.39) vs. (1.67±0.34), t=4.28] was higher than those in the control group ( P<0.01), and the level of CD8 + [(28.43±2.58) % vs. (31.29±2.47) %, t=5.72] was lower than that of control group ( P<0.01). Serum IL-2 [(46.49±6.07) μg/L vs. (53.43±7.08) μg/L, t=5.31], CXCL9 [(16.32±3.45) μg/L vs. (19.98±3.53) μg/L, t=5.30] and hs-CRP [(11.22±3.85) mg/L vs. (15.75±3.92) mg/L, t=5.89] were lower than those in the control group ( P<0.01). During treatment, the incidence of adverse reactions was 11.76% (6/51) in the observation group and 7.84% (4/51) in the control group, without statistical significance ( χ2=0.44, P=0.505). Conclusion:Jianpi Yishen Xiezhuo Decoction can effectively improve the TCM syndrome and residual kidney function of patients with end-stage renal disease undergoing peritoneal dialysis, enhance their immunity, inhibit the expression of inflammatory factors, and improve clinical efficacy with good safety.