OBJECTIVE To establish the fingerprint of Pinghuo tea standard decoction and a method for determination of multi-component to clarify the transfer relationship of quantities and quality from pieces and standard decoction. METHODS Fifteen batches of Pinghuo tea standard decoction were prepared and the extract rate was determined； the fingerprint of the preparation was established by using high-performance liquid chromatography（HPLC）； the similarity evaluation and the determination of common peaks were performed， and chemometric analysis was performed； the same method was used to determine the content of indicator components and the transfer rate was calculated. The chromatographic column was Venusil C18 column with mobile phase consisted of acetonitrile-0.1% phosphoric acid solution （gradient elution）； the column temperature was 30 ℃， and the detection wavelengths were 238 nm （0-37 min， 85-102 min） and 330 nm （37-85 min） at a flow rate of 1.0 mL/min with an injection volume of 10 μL. RESULTS The similarity of HPLC fingerprints for 15 batches of Pinghuo tea standard decoction was not lower than 0.968. A total of 24 common peaks were calibrated and 9 peaks were recognized， which were as follows neochlorogenic acid （peak 3）， chlorogenic acid （peak 6）， geniposide （peak 9）， glycyrrhizin （peak 10）， galuteolin （peak 11）， isochlorogenic acid A （peak 14）， luteolin （peak 21）， kaempferol （peak 23） and glycyrrhizic acid （peak 24）. Cluster analysis， principal component analysis and orthogonal partial least squares discriminant analysis showed consistent results， all of which could classify the 15 batches of samples into three categories. The linear range of indicator components in 15 batches of Pinghuo tea standard decoction， such as geniposide， luteolin， isochlorogenic acid A， glycyrrhizin， and glycyrrhizic acid， were 0.020 580-0.411 600， 0.001 617-0.080 850， 0.006 076-0.607 600， 0.005 125-0.071 740， and 0.017 288-0.432 200 mg/mL， respectively； RSDs of precision， repeatability， stability and recovery rate tests were all not higher than 4% （n＝6）. The mass fractions ranged 3.227 9-10.002 2， 0.297 4-0.554 6， 3.350 1-6.159 6， 0.720 6-1.073 3， 2.003 1-3.030 1 mg/g； transfer rates from the pieces and standard decoction were 19.762 8%-35.840 5%， 12.123 3%-21.254 0%， 46.097 2%-82.869 4%， 58.708 8%-91.629 6%， 39.114 3%-63.710 6%. The transfer rates of the extract from 15 batches of Pinghuo tea standard decoction ranged from 61.15%-84.68%. CONCLUSIONS Established HPLC fingerprint and content determination methods in this study are simple and accurate， which can provide reference for the quantitative value transfer study， quality control， clinical application and the development of subsequent formulations of Pinghuo tea standard decoction.

Objective To explore the effect of Huangqi Yanghe Decoction on wound healing of diabetic foot ulcer(DFU)rats based on phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/nuclear factor-κB(NF-κB)signal pathway.Methods DFU rat model was constructed,and 48 rats successfully modeled were randomly divided into the model group,the Huangqi Yanghe Decoction low(8.5 g/kg)group,the Huangqi Yanghe Decoction high(17 g/kg)dose group and the Huangqi Yanghe Decoction high dose(17 g/kg)+LY294002(PI3K/AKT pathway inhibitor,0.3 mg/kg)group.There were 12 rats in each group.Another 12 rats were selected as the control group.Rats in each group were given corresponding drug intervention for 4 weeks.After the 14th and 28th day-administration,the general state and wound changes of rats were observed,and the wound healing rate was calculated.The fasting blood glucose(FBG)level of rats was measured,and the percutaneous partial pressure of oxygen(TcpO2)of tissue around the wound was detected.Serum levels of vascular endothelial growth factor(VEGF),hypoxia inducible factor-1α(HIF-1α),C-reactive protein(CRP)and interleukin(IL)-6 were determined by enzyme linked immunosorbent assay.Histopathological changes of the wound were observed by hematoxylin-eosin staining.Immunohistochemical staining was used to measure the microvascular density of rat wound tissue.The protein expression levels of PI3K,phosphorylated PI3K(p-PI3K),AKT,phosphorylated AKT(p-AKT),NF-κB p65,phosphorylated NF-κB p65(p-NF-κB p65)and NF-κB inhibitory protein α(IκB-α)in rat wound tissue were determined by Western blot assay.Results Rats in the control group had smooth hair color,normal diet,drinking water and excretion,more active,wound healing fast,less inflammatory reaction in wound tissue,and there were more new blood vessels.Fibroblasts and collagen matrix were abundant in granulation tissue.In the model group,the fur color of rats was dull and matte,and the activity was reduced.The symptoms of polydipsia,polyphagia and polyuria were appeared in the model group,the wound color was dark,and edema and ulcer appeared in the surrounding tissue,a large number of inflammatory cells infiltrated in the wound tissue,accompanied by tissue necrosis and exudation,fewer neovascularization and fibroblasts were observed.Wound healing rate,TcpO2 in wound surrounding tissue,serum VEGF,HIF-1α,microvascular density,p-PI3K,p-AKT and IκB-α protein expression levels in wound tissue were decreased,and FBG,serum CRP,IL-6,p-NF-κB p65 protein expression in wound tissue were increased(P＜0.05).Compared with the model group,the state of rats was gradually improved in the Huangqi Yanghe Decoction low and high dose groups,and the lesion degree of wound tissue was reduced successively,wound healing rate,TcpO2 in wound surrounding tissue,serum VEGF,HIF-1α,microvascular density,p-PI3K,p-AKT and IκB-α protein expression levels in wound tissue were increased in turn(P＜0.05).The FBG,serum CRP,IL-6 and p-NF-κB p65 protein expression in wound tissue were decreased in turn(P＜0.05).LY294002 could partially reverse the therapeutic effect of high-dose Huangqi Yanghe Decoction on DFU rats(P＜0.05).Conclusion Huangqi Yanghe Decoction can regulate PI3K/AKT/NF-κB pathway,inhibit inflammatory response in DFU rats,promote angiogenesis and thus promote wound healing.

BACKGROUND:Rheumatoid arthritis is a chronic autoimmune disease characterized by joint pain,swelling,and dysfunction.Acupuncture,as a traditional medical treatment,has proved its effectiveness and safety in many diseases.However,the efficacy of acupuncture in the treatment of rheumatoid arthritis remains controversial.Therefore,the purpose of this study is to evaluate and explore the effect of Tiaodu Tongmai acupuncture in the treatment of preclinical rheumatoid arthritis of different ages through the generalized estimating equation,and to provide a basis for the application of acupuncture in rheumatoid arthritis. OBJECTIVE:To investigate the effect of Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis(pre-RA)patients at different ages based on generalized estimating equation. METHODS:A total of 123 patients with preclinical rheumatoid arthritis treated from January to September 2023 were selected as the study objects and divided into study group(n=64)and control group(n=59)according to different treatment methods.The study group was given Tiaodu Tongmai acupuncture treatment,and the control group was given acetaminophen tablets.The baseline balance was adjusted by propensity score matching method.The clinical efficacy and cytokine levels before and after treatment between the two groups were compared.The generalized estimating equation model was established to evaluate the efficacy of Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis patients at different ages. RESULTS AND CONCLUSION:(1)After 0 days of treatment,there were significant differences in joint pain and C-reactive protein expression between study and control groups(P＜0.05).After 4 weeks of treatment,there were significant differences in visual analogue scale scores,joint pain,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).After 8 weeks of treatment,there were significant differences in visual analogue scale scores,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).After 12 weeks of treatment,there were significant differences in visual analogue scale scores,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).(2)The total effective rate of the study group was 93.75%,while that of the control group was 79.17%.The clinical efficacy of the study group was significantly better than that of the control group(P＜0.05).(3)There were significant differences in interleukin-6,interferon-γ,macrophage migration inhibitory factor,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,metallomatrix proteinase 9,and anti-cyclic citrulline antibody in the study group before and after treatment(P＜0.05).The levels of interleukin-6,interferon-γ,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,metallomatrix proteinase 9,and anti-cyclic citrulline antibody in the control group after treatment were significantly different from those before treatment(P＜0.05).There were significant differences in interleukin-6,interferon-γ,macrophage migration inhibitory factor,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,and anti-cyclic citrulline antibody between the two groups after treatment(P＜0.05).(4)After 12 weeks of treatment,the comprehensive efficacy of patients of all ages in the study group was better than that of the control group(P＜0.05).After 8 weeks of treatment,the comprehensive efficacy of patients aged 23-35,36-50,and 51-60 years old in the study group was better than that of the control group(P＜0.05),and the comprehensive efficacy of patients aged 18-22 years old was comparable between the two groups.After 4 weeks of treatment,the comprehensive efficacy of patients aged 36-50 and 51-60 years old in the study group was better than that of the control group(P＜0.05),and the comprehensive efficacy was comparable between the two groups of patients aged 18-22 and 23-35 years.Overall,Tiaodu Tongmai acupuncture therapy has advantages in treating preclinical rheumatoid arthritis patients aged 36-50 and 51-60 years.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Objective:To describe the study methods and baseline characteristics of participants enrolled in mCessation program.Methods:This is a longitudinal, real-world study with non-randomized controlled design. The mCessation program consisted of a WeChat official account, an applet and a website using the same name ‘mCessation Online’. After users followed the WeChat account, filled in baseline information online and set a quit date, they would receive 162 short text messages in the next six and a half months as scheduled. This study collected the information of participants enrolled from May 26, 2021 to September 30, 2022, and analyzed baseline data including demographic characteristics, smoking characteristics, degree of tobacco dependence, reasons for smoking cessation and other related factors.Results:During the study period, a total of 16 746 participants registered, and 13 887 participants (82.9%) were enrolled in final analysis after screening the inclusion and exclusion criteria and completion of main indicators. Each year the number of enrolled participants in May or June was 1 381 to 2 707 per month, higher than the number of enrolled participants in other months (233 to 569 per month). Participants from North China accounted for the largest proportion (29.3%). There were 13 316 men (95.9%) in enrolled participants and the mean age was (36±10) years. Most participants were 25-34 (38.8%) or 35-44 (30.8%) years old. In terms of smoking characteristics, there were 12 564 (90.5%) daily smokers. The starting age of smoking was 18 (15, 20) years old. 11 866 participants (85.4%) were tobacco dependent, mostly with degree of mild (76.4%) or moderate (20.2%). In terms of reasons for quitting, 9 315 participants′ (67.1%) reasons were to prevent disease, 6 742 participants (48.5%) were concerned about impact of smoking on family members, and 6 731 participants (48.5%) were under requested by families.Conclusion:mCessation program can effectively recruit smokers with intention to quit in short time, especially those who were male, young and tobacco dependent.

Objective:To establish a multi-component exercise intervention program for the elderly with frailty, assess its effectiveness on improving the severity of frailty, and examine the effects of different intervention modes.Methods:174 elderly people in a community in Beijing were randomly divided into three groups.The control group did not receive special intervention.The health education group received lectures, demonstrations and pamphlets on basic knowledge about frailty and instructions about a multi-component sports program.The multi-component exercise training program group was trained for three months via regular videos delivered through a WeChat app.The severity of frailty and exercise adherence of subjects in the three groups were compared.Results:166 subjects completed the study.Frailty phenotype(FP)scores of the health education group and the WeChat app group were lower than those at baseline( P<0.05).After intervention, FP scores of the control group, the health education group and the WeChat app group were 1(1, 2), 1(0, 1)and 1(0, 1), respectively, and there were differences among the three groups after intervention( H=15.539, P<0.05).There were 10 subjects(17.2%)in the control group, 15(25.9%)in the health education group and 28(48.3%)in the WeChat app group who experienced reversal from frailty or pre-frailty to no frailty( χ2=12.770, P=0.002).The number of people who reversed to no frailty in the WeChat app group was higher than in the control group( χ2=11.536, P=0.001)and the health education group( χ2=5.659, P=0.014).The numbers of people with frailty in the control group, health education group and WeChat app group were 9(15.5%), 1(1.7%)and 1(1.7%), respectively( χ2=13.040, P=0.001), with the numbers of frailty cases in the health education group and the WeChat app group lower than in the control group( χ2=7.552, 7.210, P=0.006, 0.007).The percentage of people completing the exercise program in the WeChat app group was higher than in the control group( χ2=49.366, P<0.001)and also in the health education group( χ2=26.481, P<0.001), while the percentage of people completing the exercise program in the health education group was higher than in the control group( χ2=6.171, P=0.013). Conclusions:The multi-component exercise program can improve the frailty state of the elderly, and the intervention method based on the WeChat app has clear advantages in improving frailty and enhancing exercise adherence.

Objective:To explore the current status of instrumental activities of daily living among community-dwelling older adults (≥ 75 years old) in China, and analyze its influencing factors.Methods:This study was a cross-sectional study. From January to May 2023, multi-stage sampling was used to select 1 832 older adults from 27 community health service centers in 9 provinces and cities across China as the research subject. A survey was conducted on older adults using the General Information Questionnaire and the Lawton-Brody Instrumental Activities of Daily Living Scale. Binomial Logistic regression was used to analyze the influencing factors of instrumental activities of daily living among older adults in the community. A total of 1 832 questionnaires were distributed, and 1 746 valid questionnaires were collected, with an effective response rate of 95.30%.Results:Among 1 746 older adults in the community, 1 194 (68.4%) had functional dependence of instrumental activities of daily living. Binomial Logistic regression showed that age, educational level, type of residence, type of chronic disease, regular exercise, self-reported social support, self-reported visual impairment, and self-reported hearing impairment were the influencing factors for the functional dependence of instrumental activities of daily living among older adults in the community ( P<0.05) . Conclusions:The instrumental activities of daily living among older adults in communities in China needs to be improved. Nurses can identify high-risk populations in the early stages and develop intervention measures based on the influencing factors of older adults' instrumental activities of daily living.

Objective:To investigate the effect of somatostatin receptor ligands (SRLs) on bone metabolism in patients with acromegaly.Methods:Retrospective analysis of clinical data of acromegaly patients( n=100) received surgery or SRLs alone for 3 months. The changes of growth hormone (GH), insulin-like growth factor-1 (IGF-1), osteocalcin (OC), N-mid fragment of osteocalcin (N-MID), amino-terminal peptide of type I procollagen (P1NP) and C-terminal peptide degradation product of type I collagen(CTX) were compared before and after treatment. Patients were divided into drug treatment group and surgical group according to treatment methods. According to the decline of GH after medication, patients in the drug treatment group were further divided into drug sensitive group and drug insensitive group. Results:The average dynamic GH and IGF-1 indexes in the drug treatment group were significantly decreased after treatment compared with before treatment (both P<0.05), and CTX was also significantly decreased after treatment [1.25 (0.67, 1.40) ng/mL vs 1.34 (0.57, 1.68) ng/mL, P<0.05]. The mean dynamic GH, IGF-1 index, OC, N-MID, P1NP, and CTX in surgical group were significantly decreased after treatment compared with before treatment (all P<0.01). In the surgical group, there was a positive correlation between GH difference (ΔGH) and N-mid difference (ΔN-MID; r=0.454, P=0.026), and there was a positive correlation between IGF-1 index difference (ΔIGF-1 index) and CTX difference (ΔCTX; r=0.339, P=0.036). After treatment, the mean dynamic GH, IGF-1 index, CTX, P1NP, and N-MID in drug treatment group were significantly higher than those in surgical group (all P<0.001). CTX and N-MID decreased significantly after treatment in drug sensitive group compared with drug insensitive group (35.3% vs 7.2%, P<0.001; 24.1% vs 11.8%, P<0.05), and ΔGH was positively correlated with ΔCTX ( r=0.328, P=0.004). Conclusion:SRLs treatment can reduce bone formation marker N-MID and bone resorption marker CTX, improving the high turnover state of bone metabolism in patients with acromegaly, which may attribute to the reduction of GH and IGF-1 levels.

Objective:To understand the application effect of traditional position and oblique supine lithotomy in percutaneous nephroscopy combined with ureteroscopy combined with double lithography, and explore the clinical nursing methods of oblique supine lithotomy.Methods:From January 2018 to January 2019 in our hospital, 82 patients with complicated calculi who underwent percutaneous nephroscopy combined with ureteroscopy and double lithoscopy were selected, and were divided into the control group ( n=40) and the observation group according to the random number table ( n=42). The control group took the lithotomy position after anesthesia, placed the ureteral stent tube and changed it to the prone position to complete the operation; the observation group placed the oblique supine lithotomy position to complete the operation after anesthesia, and there was no need to change the position during the operation. The posture time, blood pressure, heart rate, pulse oxygen, blood transfusion, bleeding, postoperative postural comfort and complications of the two groups were compared. Results:When placed in the position and at the end of the operation, the blood pressure of the control group was (109±31), (106±23) mmHg(1 mmHg=0.133 kPa), and the heart rate was (93 ±10), (95±15)times per minute; the blood pressure of the observation group was (130±19), (125±17)mmHg, the heart rate was (86±12), (85±9) times per minute, the difference between the two groups was statistically significant ( t value was 2.86-4.26, P<0.01). The posture time of the observation group was (12.4±3.0) min and the control group was (21.2±6.9) min with statistically significant difference between two groups( t value was 7.550, P<0.01). The number of uncomfortable patients in the observation group after operation was 3 cases and 7 cases occurred in the control group. The difference was statistically significant ( χ2 value was 2.450, P<0.05). Conclusion:It is safe and feasible to use the oblique supine lithotomy position in double -lens combined stone removal, which can reduce the patient's discomfort and complications, and effectively improve the surgical efficiency and quality.

Objective:To establish a disease risk prediction model for the newborn screening system of inherited metabolic diseases by artificial intelligence technology.Methods:This was a retrospectively study. Newborn screening data ( n=5 907 547) from February 2010 to May 2019 from 31 hospitals in China and verified data ( n=3 028) from 34 hospitals of the same period were collected to establish the artificial intelligence model for the prediction of inherited metabolic diseases in neonates. The validity of the artificial intelligence disease risk prediction model was verified by 360 814 newborns ' screening data from January 2018 to September 2018 through a single-blind experiment. The effectiveness of the artificial intelligence disease risk prediction model was verified by comparing the detection rate of clinically confirmed cases, the positive rate of initial screening and the positive predictive value between the clinicians and the artificial intelligence prediction model of inherited metabolic diseases. Results:A total of 3 665 697 newborns ' screening data were collected including 3 019 cases ' positive data to establish the 16 artificial intelligence models for 32 inherited metabolic diseases. The single-blind experiment ( n=360 814) showed that 45 clinically diagnosed infants were detected by both artificial intelligence model and clinicians. A total of 2 684 cases were positive in tandem mass spectrometry screening and 1 694 cases were with high risk in artificial intelligence prediction model of inherited metabolic diseases, with the positive rates of tandem 0.74% (2 684/360 814)and 0.46% (1 694/360 814), respectively. Compared to clinicians, the positive rate of newborns was reduced by 36.89% (990/2 684) after the application of the artificial intelligence model, and the positive predictive values of clinicians and artificial intelligence prediction model of inherited metabolic diseases were 1.68% (45/2 684) and 2.66% (45/1 694) respectively. Conclusion:An accurate, fast, and the lower false positive rate auxiliary diagnosis system for neonatal inherited metabolic diseases by artificial intelligence technology has been established, which may have an important clinical value.