Objective:To optimize the alcohol precipitation process of Quhan Zhufeng Granules.Methods:Taking the volume fraction of ethanol, the relative density of the concentrated solution and the standing time as the investigation factors, the Z value of the total evaluation of gentiopicrin content, oleanolic acid content and dry paste yield of gentiana macrophylla as the evaluation indexes, the star-point design-response surface method was used to optimize the alcohol precipitation process.Results:The optimal the alcohol precipitation process of Quhan Zhufeng Granules: concentration relative density 1.08 g/ml (90-95 ℃), alcohol precipitation at the end of volume fraction of 62% ethanol, standing for 16 h.Conclusion:The alcohol precipitation process using overall desirability and central composite design is stable and feasible, and has good predictability, which can provide experimental basis for further scale production.

Objective:To investigate the level of healthy fitness in preschool children with autism spectrum disorder(ASD),to explore the factors influencing healthy fitness in children with ASD,and to provide reference for their comprehensive rehabilitation treatment and home exercise guidance. Method:Fifty children in the ASD group and 50 children in the normal group were selected to test the health fitness level using seven indexes:body mass index,20m round-trip run,tennis long throw,standing long jump,isometric push-up,one-legged stance,and seated forward bend.The differences in health fitness levels between preschool children with ASD and normal children were analyzed using independent samples t-test,and the effects of gender,BMI,average daily sleep time,average daily sedentary time,average daily TPA time,average daily MVPA time,mother's education level,father's education level,family income,and age of child's primary caregiver on health fitness of preschool children with ASD were analyzed using multiple linear regression models. Result:Comparative analysis between groups showed that the ASD group had a much lower tennis ball toss than the normal group(P＜0.05),and significantly lower scores in the 20-meter round-trip run,isometric push-ups and one-leg stand test than the normal group(P＜0.001),while the differences in body mass index,stand-ing long jump and seated forward bend scores were not statistically significant(P＞0.05).Multiple linear regres-sion model analysis showed that the mean daily sleep,Total Physical Activity(TPA),and Moderate to Vigor-ous Intensity Physical Activity(MVPA)time had a good fit for the 20 m round-trip run(20 m round-trip run=-9.561+1.048 x average daily sleep time+0.076 x average daily TPA time+0.066 × average daily MVPA time);average daily TPA time was well fitted for the isometric push-ups(isometric push-ups=-87.625+0.428x average daily TPA time);average daily TPA and MVPA times were well fitted for the single-leg stand(aver-age duration of single-leg stand=6.627+0.094 x average daily total physical activity time+0.071 x average daily moderate-to-vigorous activity time). Conclusion:The cardiopulmonary fitness,motor fitness and upper limb muscle fitness of preschool children with ASD are lower than those of normal children,and physical fitness training should be included in the comprehensive rehabilitation intervention program.The longer sleep time,the longer TPA time and the longer MVPA time may suggest the better cardiorespiratory fitness and motor fitness of preschool children with ASD,and the effective duration of sleep time and moderate-to-vigorous physical activity of preschool children with ASD should be enhanced.

The idiopathic inflammatory myopathies encompass a diverse array of autoimmune diseases,characterized by muscular inflammation and various extramuscular manifestations.These conditions have the poten-tial to impact multiple organs,including the lungs,skin,joints,gastrointestinal tract,and heart.The defining features of these conditions are muscle weakness and myalgia.Although cardiac involvement is infrequent,its clinical manifestations are subtle and easily overlooked.Cardiac damage represents a significant contributor to mortality and morbidity in patients with idiopathic inflammatory myopathy.Early and accurate identification of cardiac involve-ment may facilitate improved patient outcomes.This article provides an overview of the potential etiology,clinical presentations,risk factors,biomarkers,and imaging studies for early diagnosis of cardiac involvement in idio-pathic inflammatory myopathy.This review aims to enhance clinicians'understanding and diagnostic capabilities re-garding cardiac involvement in idiopathic inflammatory myopathy while promoting early intervention strategies for lifelong management and improved prognosis.

Objective:To explore the current status and influencing factors of fertility intention to have a third child among childbearing age women in Heilongjiang Province under three-child policy.Methods:From January to April 2023, convenience sampling was used to select 10 600 women of childbearing age from ten districts and counties in five cities in Heilongjiang Province (Jiamusi, Qiqihar, Harbin, Heihe, Suihua) as research subjects. The Fertility Intention to Have a Third Child Questionnaire among Childbearing Age Women in Heilongjiang Province was used to investigate women of childbearing age. Multi-class Logistic regression was used to explore the influencing factors of fertility intention of childbearing age women to have a third child.Results:A total of 10 600 questionnaires were distributed, and 9 554 valid questionnaires were collected, with a valid response rate of 90.13% (9 554/10 600). Among 9 554 women of childbearing age, 2 248 had the intention to have a third child, 5 036 had no intention, and 2 270 were uncertain. Multi-class Logistic regression analysis showed that age, education level, per capita monthly income of the family, occupation, fertility status, pregnancy complications, economic pressure to have a third child, parents' attitudes towards having a third child, and satisfaction with childcare services were the influencing factors of the fertility intention of childbearing age women in Heilongjiang Province to have a third child ( P<0.05) . Conclusions:Under the three-child policy, women of childbearing age in Heilongjiang Province have a low intention to have a third child. Relevant departments should formulate policies based on the influencing factors.

The global COVID-19 coronavirus pandemic has infected over 109 million people, leading to over 2 million deaths up to date and still lacking of effective drugs for patient treatment. Here, we screened about 1.8 million small molecules against the main protease (M^pro) and papain like protease (PL^pro), two major proteases in severe acute respiratory syndrome-coronavirus 2 genome, and identified 1851M^pro inhibitors and 205 PL^pro inhibitors with low nmol/l activity of the best hits. Among these inhibitors, eight small molecules showed dual inhibition effects on both M^pro and PL^pro, exhibiting potential as better candidates for COVID-19 treatment. The best inhibitors of each protease were tested in antiviral assay, with over 40% of M^pro inhibitors and over 20% of PL^pro inhibitors showing high potency in viral inhibition with low cytotoxicity. The X-ray crystal structure of SARS-CoV-2 M^pro in complex with its potent inhibitor 4a was determined at 1.8 Å resolution. Together with docking assays, our results provide a comprehensive resource for future research on anti-SARS-CoV-2 drug development.
Humans ; Antiviral Agents/chemistry* ; COVID-19 ; COVID-19 Drug Treatment ; High-Throughput Screening Assays ; Molecular Docking Simulation ; Protease Inhibitors/chemistry* ; SARS-CoV-2/enzymology* ; Viral Nonstructural Proteins

Objective:To construct a practical teaching system for the undergraduate midwifery majors based on job competence.Methods:Based on the core competencies of the midwife position proposed by the International Confederation of Midwives, and using the Competency Outcomes and Performance Assessment as the construction tool, literature research, group interviews, and the Delphi expert consultation were used to conduct two rounds of consultation with 18 experts to construct a practical teaching system for undergraduate midwifery majors based on job competence.Results:In the two rounds of expert consultation, the effective recovery rates of the questionnaire were 100% (20/20), 94.44% (17/18), the expert authority coefficients were 0.70 to 0.95, 0.75 to 0.95, the Kendall's W were 0.49 and 0.65 ( P<0.05), and the coefficients of variation of indicators at all levels were 0.05 to 0.23, 0.05 to 0.18. The final practical teaching system for undergraduate midwifery majors included four practical teaching sections, including pregnancy healthcare, childbirth healthcare, postpartum healthcare, and comprehensive professional competence and literacy, as well as 13 core skills. Conclusions:The practical teaching system for undergraduate midwifery majors based on job competence is scientific, practical, and operable, which can provide reference for the development and implementation of practical teaching in undergraduate midwifery majors.

Objective:To evaluate the practical effects of perioperative diet optimization in pediatric fracture surgery, and explore the clinical efficacy and application value of circular management combined with diet optimization.Methods:Totally 76 children with selective fracture surgery were selected from May 2020 to October 2020 admitted to Wuxi 9th People′s Hospital Affiliated to Soochow University. They were divided into experimental group (38 cases) and control group (38 cases) by random number table method. Experimental group conducted circular management combined with diet optimization for nursing, while control group used only simple diet optimization management. The time and the amount of fasting before and after operation of two groups were recorded, and the compliances of two groups were evaluated according to the total amount of intake. The incidence of subjective adverse feelings, including hunger, thirst, dizziness, fatigue and nausea, were observed. And the satisfactions of patients with nursing management were also evaluated.Results:The preoperative fasting time, preoperative drinking prohibition time, postoperative diet recovery time were (8.25 ± 1.56), (2.76 ± 0.69), (1.17 ± 0.58) h in experimental group, and (9.79 ± 2.51), (3.47 ± 1.18), (1.50 ± 0.80) h in control group, and the differences were statistically significant ( t=-3.21, -3.17, -2.07, all P<0.05). The compliance rates to nursing and fasting before and after operation in control group were 57.9% (22/38), 65.8% (25/38), 76.3% (29/38) and 81.6% (31/38) respectively, which were significantly lower than all 100.0% (38/38) in experimental group ( P<0.05). During preoperative period (hunger), postoperative period when allowing intake (hunger, thirst, dizziness, feebleness) and 6 hours after intake (thirst, feebleness), the incidences of subjective adverse feelings in experimental group were statistically lower than those in control group ( Z values were -3.17- -1.97, all P<0.05). The satisfaction to dietary nursing management in experimental group was (93.82 ± 4.57) scores, which remained higher than (87.24 ± 6.65) scores in control group, and the difference was statistically significant ( t=5.03, P<0.01). Conclusions:Single perioperative diet optimization can easily be affected by the unstable clinical compliance of traumatic children, resulting in a low implementation rate. The combination of circular management and diet optimization can improve the intervention implementation and treatment compliance, shorten the time of diet prohibition, accelerate the postoperative recovery, and reduce the occurrence of perioperative adverse reactions.

ObjectiveTo analyze the characteristics of death and premature death of 4 major chronic diseases （cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes） in Taizhou City from 2011 to 2018，and provide data basis for the government to formulate chronic disease prevention planning. MethodsThe death data of household registration residents in Taizhou City from 2011 to 2018 were derived from the Chronic Disease Surveillance Information Management System in Zhejiang Province. The death toll ratio of chronic diseases， the mortality rate of chronic diseases， the probability of premature death of chronic diseases were analyzed. The standardization rate was calculated six times in 2010. Population composition of the census. The Joinpoint Regression Program 4.2 software was used for calculating annual percent change （APC） and its statistical test results. ResultsFrom 2011 to 2018， there were 231 724 chronic disease deaths in Taizhou City， with a mortality rate of 486.52/10⁵ and a standardized mortality rate of 381.55/10⁵. The proportion of chronic disease deaths to total deaths was 79.89%， of which males were higher than females and rural areas were higher than urban areas.From 2011 to 2018， the standardized mortality and early death probability of cardiovascular and cerebrovascular diseases， malignant tumors and chronic respiratory diseases in Taizhou showed a downward trend （P<0.05）， the standardized mortality of diabetes （P=0.46） and the early death probability （P=0.22） did not decline， and the mortality of all age groups of the above four types of chronic diseases in rural areas was higher than that in urban areas. The mortality of the four types of chronic diseases from high to low are cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes， and the mortality tends to increase with age. From 2011 to 2018， the probability of premature death from four types of chronic diseases in Taizhou City showed a downward trend， from 13.49% in 2011 to 10.49% in 2018， with an average annual decrease of 2.97%. The difference was statistically significant （t=‒5.83，P<0.05）. ConclusionChronic disease death is the main cause of death in Taizhou City. In order to reduce the mortality rate of chronic diseases， effective prevention and control measures for chronic diseases should be carried out， especially the prevention and control of diabetes and male chronic diseases.

Objective:To investigate the diagnostic and prognostic value of D-dimer level in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF).Methods:A total of 142 cases diagnosed with ACLF were randomly selected as research objects in the open cohort using the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF). Plasma D-dimer levels were compared between patients with ACLF and non-ACLF and patients with different ACLF grades. Survival and death group D-dimer levels were compared with the end points of 28 days and 90 days, respectively. The correlation between D-dimer and other laboratory indicators and prognostic scores were investigated. Area under receiver operating characteristic curve (AUROC) was used to evaluate the D-dimer value for predicting the prognosis of ACLF patients. 125 external ACLF cases were used for validation. A Student t test or Mann-Whitney U test was used to compare continuous measurement data between two groups. Kruskal-Wallis test was used to compare continuous measurement data between multiple groups.Results:Plasma D-dimer levels in the ACLF [2 588.5 (1 142.8, 5 472.8) μg/L] ] and non-ACLF group [1 385.5 (612.0, 3 840.3) μg/L] had a significant difference ( P<0.001). ACLF-3 patients had significantly higher D-dimer levels than ACLF-1/2 patients (ACLF-3 vs. ACLF-1, P<0.001; ACLF-3 vs. ACLF-2, P<0.05). Patients who died at 28/90 days had significantly higher D-dimer levels than those whom survived ( P<0.001). There was a significant positive correlation between D-dimer level with prothrombin time (PT), international normalized ratio (INR), high-density lipoprotein C, as well as various prognostic scores (COSSH-ACLFs, CLIF-C ACLFs, CLIF-OFs, MELDs). AUROC of D-dimer in predicting the prognosis of ACLF patients at 28 days and 90 days was 0.751 (95% CI: 0.649-0.852) and 0.787 (95% CI: 0.695-0.878), respectively, which did not differ significantly compared with the predictive ability of other scores ( P<0.05), and similar results were confirmed by an external validation group of 125 cases. Conclusion:D-dimer level is significantly higher in patients with ACLF, so it is an independent predictor of prognosis at 28 and 90 days.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe diseases. This study aimed to validate the predictive ability of risk models in patients with SJS/TEN and propose possible refinement in China. Patients in the Department of Dermatology of Huashan Hospital from January 2008 to January 2019 were included. Results showed that the severity-of-illness score for TEN (SCORTEN) had a good discrimination (area under the receiver operating characteristic curve (AUC), 0.78), and it was superior to auxiliary score (AS) and ABCD-10, which indicates age, bicarbonate level, cancer, dialysis, and 10% involved body surface area (AUC, 0.69 and 0.68, respectively). The calibration of SCORTEN (Hosmer-Lemeshow goodness-of-fit test, P = 0.69) was also better than that of AS (P = 0.25) and ABCD-10 (P = 0.55). SCORTEN and ABCD-10 were similar (Brier score (BS), 0.04 and 0.04) in terms of accuracy of predictions. In addition, the imaging appearance of pulmonary consolidation on computed tomography was associated with high mortality. Refined models were formed using the variables and this imaging appearance. The refined AS and ABCD-10 models were similar in discrimination compared with the original SCORTEN (0.74 vs. 0.78, P = 0.23; 0.74 vs. 0.78, P = 0.30, respectively). Therefore, SCORTEN showed good discrimination performance, calibration, and accuracy, and refined AS or ABCD-10 model may be an option when SCORTEN variables are not available.
Cohort Studies ; Humans ; Retrospective Studies ; Severity of Illness Index ; Stevens-Johnson Syndrome/diagnostic imaging* ; Tomography