Objective To investigate the changes of macular microcirculation and aqueous humor cytokine expression in patients with diabetic macular edema(DME)after anti-vascular endothelial growth factor(VEGF)treatment,and analyze the relationship with efficacy.Methods A total of 62 patients(91 eyes)with DME who were treated in the First Hospital of Nanchang from October 2021 to August 2023 were selected and treated with intravitreal injection of conbercept.According to the reduction of central macular thickness(CMT),they were divided into efficacy significant group(CMT reduction≥100μm,59 eyes)and non-efficacy significant group(CMT reduction＜100μm or increase,32 eyes).The changes of CMT,vessel density(VD)of superficial capillary plexus(SCP),fovea avascular area(FAZ),VEGF,interleuki(IL)-6,IL-8,and IL-10 after anti-VEGF treatment were analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each index.Results Before treatment,the levels of VEGF and IL-10 in aqueous humor in efficacy significant group were significantly higher than those in non-efficacy significant group,and the level of IL-8 was significantly lower than that in non-efficacy significant group(P＜0.05).After treatment,levels of VEGF,IL-6,IL-8 and IL-10 in aqueous humor in both groups were significantly lower than before treatment(P＜0.05).The levels of VEGF,IL-6 and IL-8 in aqueous humor in efficacy significant group were significantly lower than those in non-efficacy significant group,and the level of IL-10 was significantly higher than that in non-efficacy significant group(P＜0.05).Before and after anti-VEGF treatment,there were no significant changes in FAZ area and SCP-VD in both groups(P＞0.05).Correlation analysis showed that VEGF(r=0.571,P＜0.001)and IL-10(r=0.382,P=0.008)in aqueous humor at baseline were positively correlated with CMT reduction,IL-8 was negatively correlated with CMT reduction(r=-0.689,P＜0.001).IL-6,FAZ area and SCP-VD were not correlated with CMT reduction(P＞0.05).Cytokine levels were not correlated with FAZ area and SCP-VD(P＞0.05).ROC curve results showed that area under the curve of IL-8,VEGF and IL-10 at baseline predicting anti-VEGF efficacy were 0.825,0.813 and 0.676,respectively.Conclusion The levels of VEGF,IL-8,and IL-10 in aqueous humor at baseline in DME patients were correlated with anti-VEGF efficacy and could predict the efficacy of anti-VEGF.

Objective:To investigate the correlation of the expression of Ephrin A receptor 2(EphA2)and its promoter region DNA hypomethylation with the occurrence of pyroptosis in invasive breast cancer. Methods:The expression level of pyroptosis-related protein EphA2 in normal breast tissue,paracancerous tissues and cancer tissues from 42 breast cancer patients was examined by Immunofluorescence staining and Western blotting.The expression level of pyroptosis related protein nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)was analyzed by immunofluorescence staining and Western blotting.The expression levels of apoptosis related proteins Caspase 1 and inflammatory cytokine interleukin-1β(IL-1 β)were studied by Western blotting.The DNA methylation level in the promoter region of EphA2 was investigated by nested methylation-specific PCR(nMS-PCR).The expression levels of DNA methyltransferase 1(DNMT1)and DNA methyltransferase 3a(DNMT3a)were examined by Western blotting.The correlation of the protein expression and methylation level of EphA2 in cancer tissues with the expression NLRP3,Caspase 1,IL-1 β,DNMT1 and DNMT3a was analyzed by Pearson correlation coefficient. Results:Compared with normal breast tissues and paracancerous tissues,the expression level of EphA2 protein was significantly increased(P＜0.01),while that of NLRP3,Caspasel and IL-1 βwas significantly decreased(P＜0.05)in breast cancer tissues.Meanwhile,compared with normal breast tissues and paracancerous tissues,the DNA methylation level of EphA2 promoter in breast cancer tissues was significantly decreased(P＜0.05),the expression level DNMT3a protein was significantly decreased(P＜0.01,P＜0.05),and the difference in the expression level of DNMT1 protein was not statistically significant.Pearson correlation analysis showed that the expression level of EphA2 protein is negatively correlated with that of NLRP3(r=-0.651 2,P＜0.05),Caspasel(r=-0.571 2,P＜0.05),IL-1β(r=-0.654 6,P＜0.05)or DNMT3a(r=-0.537 4,P＜0.05),while the methylation level of EphA2 was positively correlated with the protein expression level of NLRP3(r=0.634 1,P=0.026 8),Caspase1(r=0.672 8,P=0.01 6 5),IL-1 β(r=0.694 0,P=0.01 2 3)and DNMT3a(r=0.687 1,P=0.01 3 6). Conclusion:The expression of EphA2 protein is upregulated in breast cancer tissues is negatively correlated with pyroptosis.DNMT3a may be involved in the process of DNA hypomethylation in the promoter region of EphA2.

Objective:To study the influence of different feeding patterns on mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in pregnant women with high viral loads who received antiviral medication during pregnancy to the day of delivery.Methods:This prospective cohort study was conducted in Beijing You'an Hospital. From January 1, 2019, to March 31, 2020, and 574 pregnant women with positive hepatitis B surface antigen (HBsAg) and HBV DNA>2×10 5 IU/ml were enrolled. All participants received tenofovir, telbivudine, lamivudine, or propofol tenofovir from 24-28 weeks of gestation and discontinued on the day of delivery, and their neonates were postnatally given routine passive-active immunoprophylaxis. Based on the feeding patterns, the subjects were divided into three groups: breastfeeding ( n=257), bottle-feeding ( n=241) and mixed feeding groups ( n=76). The follow-up data were obtained from liver functions and HBV DNA level of the mothers at 6-8 weeks postpartum and HBV serological markers of infants at 7-12 months. One-way ANOVA, Student-Newman-Keuls, Chi-square test or Fisher exact test, and repeated measures ANOVA were used to analyze the data. Results:The average maternal HBV DNA levels before antiviral treatment did not differ significantly between the three groups [(7.90±0.67), (7.82±0.70), (7.83±0.70) log 10 IU/ml, F=0.912, P>0.05]. HBV DNA level before delivery in the mixed feeding group was slightly lower than that in the breastfeeding and bottle-feeding group [(3.87 ±1.08) vs (4.21±1.17) and (4.30±1.28) log 10 IU/ml, q= 3.052 and 3.831, both P<0.05], while the comparison between the latter two groups showed no significant differences ( P>0.05). After delivery, HBV DNA level in the bottle-feeding group was slightly lower than that in the breastfeeding group [(7.42±0.93) vs (7.69±0.90) log 10 IU/ml, q=4.583, P<0.05]. Among 580 infants (including six pairs of twins), only one bottle-fed infant (0.4%, 1/243) was infected with HBV through MTCT, and none in the breastfeeding or mixed feeding group ( P=0.553). Conclusions:For pregnant women with high viral loads of HBV who have received antiviral medication during pregnancy, although HBV DNA level will rebound after discontinuation upon delivery, breastfeeding is recommended considering it does not increase the risk of MTCT.

Objective:To investigate the effect of upper limb pillow position on hemodynamic and safety of patients undergoing cerebellopontine angle tumor resection.Methods:Eighty-four patients receiving cerebellopontine angle tumor resection in our hospital from January 2016 to December 2019 were randomly divided into the experimental group (42 cases) and the control group (42 cases). Patients in the control group were placed in routine upper limb position, while patients in the experimental group were placed in upper limb pillow position. The data including systolic pressure, diastolic pressure, heart rate, saturation of blood oxygen were recorded on admission of operation room, completing placing body position, 30 minutes and 60 minutes after operation and after finishing the operation. The numbness/soreness of upper limbs and pressure injury rate was compared between the experimental group and the control group.Results:The rate of numbness/soreness of upper limbs were 2.4% (1/42) in the experimental group, 19.1%(8/42) in the control group, the differences were statistically significant ( χ2 value was 6.098, P<0.05). The stage 1 pressure injury were 2 cases in the experimental group, stage 1 and 2 pressure injury were 6 cases and 2 cases, respectively in the control group, the differences were statically significant ( Z value was 2.039, P<0.05). Conclusion:Upper limb pillow position of the operation side can reduce postoperative complication of patients undergoing cerebellopontine angle tumor resection, but will not increase the risk of abnormal hemodynamic fluctuation.

Objective: To understand indoor air quality in middle and primary schools of Hangzhou in autumn and winter seasons, and to provide references of promoting indoor air quality of schools. Methods: Totally 33 classrooms of 11 schools in urban area were selected into study during Sept.2018 to Jan.2019. Daily measurements of PM2.5 and CO2 were performed in selected classes during school working time by air quality monitors. Totally, monitoring data of 35 964 hours were analyzed using univariate and multiplicity analysis for PM2.5 and CO2 level, variability and possible influence factors. Results: In autumn and winter, hourly average values of classroom PM2.5 and CO2 concentration level in Hangzhou were between 35.30 to 74.65 μg/m3 and between 949.17 to 2 029.98 mg/m3, respectively. The concentration levels of PM2.5 and CO2 were higher with the temperature(F=1 412.84, 775.66, P<0.01). No statistical significance was be found for the difference of PM2.5 concentration among monitoring times. Wave changes in CO2 were observed with time variation PM2.5 and CO2 concentration level of 68.42% monitoring times was complied with standards. School type and temperature correlated with PM2.5 concentration level. The PM2.5 concentration level in senior high school was higher than that in junior high school, while the value in primary school was the minimum(β=0.44, P<0.01). And the PM2.5 concentration increased with the temperature decreased(β=8.31, P<0.01). School type, temperature and monitoring time correlated with CO2 concentration level. CO2 concentration increased with the increase of grade, decrease in temperature and later time during the day(β=213.64, 162.38, P<0.01). The CO2 concentration level in later monitoring time was lower than that in earlier monitoring time(β=-16.28, P<0.01). Conclusion Classroom CO2 concentration level in Hangzhou was closed to that in European schools, while PM2.5 concentration level was much higher. Comparing with other cities in China, classroom PM2.5 and CO2 concentration level in Hangzhou is better. The results highlighted that school location, design and routine management should be advanced consideration for good air quality in classroom.

Objective:To investigate the current situation of the implementation of breastfeeding in the state of mother infant separation in 75 hospitals in China, based on the evidence-based guidelines for breastfeeding of hospitalized newborns (hereinafter referred to as the guidelines).Methods:Totally 75 hospitals in China were selected using the convenience sampling method to distribute questionnaires to compare the implementation of breastfeeding after separation of mother and infant.Results:All the hospitals selected in this survey were not satisfied with the overall implementation of the guide, but the general hospital's interpretation and learning of the guide was better than that of the specialized hospital, with a statistically significant difference ( χ2 value was 5.616, P <0.05); the breastfeeding rate was lower after the separation of mother and infant, and only 18.7% (14/75) of the units with the feeding rate ≥ 75%; they provided support related to breast milk collection, kangaroo nursing and professional professionals in the aspect of quality management, specialized hospital was better than general hospital, the difference was statistically significant ( χ2 values were 9.450, 10.516, 6.436, P<0.05); 62.1% (18/29) of the specialized hospitals have multi-disciplinary cooperation teams to promote the separation of mother and infant breastfeeding, while only 34.8% (16/46) of the comprehensive hospitals have multi-disciplinary cooperation teams , the difference was statistically significant ( χ2 value was 7.254, P<0.05). Conclusion:The evidence-based guidelines for breastfeeding of hospitalized newborns in China mostly refer to the relevant international standards. There are some difficulties in the implementation of the guidelines due to the large differences in the economy and policies of various regions in China. In order to improve the success rate of breastfeeding separation between mother and infant, China should establish a national standard that is in line with the national conditions, so as to facilitate the reference implementation of hospitals at all levels.

Objective: To investigate the role of CD11b agonist leukadherin-1 (LA1) in the development of intestinal inflammation and colitis disease in a mouse model of dextran sulfate sodium (DSS)-induced colitis. Methods: The mouse model of experimental colitis was induced by DSS. Body weight changes and survival status were monitored every day. The length of colons was measured at day 7. Colon tissue sections were stained with hematoxylin and eosin (HE) and observed under an optical microscope for pathological analysis. The percentages of apoptotic cells in colon tissues were observed by TUNEL staining. Myeloperoxidase (MPO) activity was measured with MPO activity detection kit. IL-1β and TNF-α levels were detected by ELISA. Macrophages and TNF-α in colon tissues were observed using immunofluorescence staining and confocal microscopy. Flow cytometry was performed to detect the changes in TLR4 expression on macrophages after stimulating mice with LA1 for 0, 3, 6 and 12 h. Moreover, TLR4 expression was also measured by Western blot after treating bone marrow-derived macrophages (BMDMs) with LA1 for 0, 3, 6 and 12 h. Unpaired t-test was used for statistical analysis. Results: Compared with the DSS group, the LA1+ DSS group presented lower mortality rate, greater body weight and longer colon and the differences between the two groups were statistically significant. Moreover, the LA1+ DSS group showed lighter pathological damages, decreased percentage of apoptotic cells and suppressed MPO activity as compared with those of the DSS group. The number of macrophages and the relative concentrations of IL-1β and TNF-α in colon tissues were lower in the LA1+ DSS group than in the DSS group, and the differences between the two groups were statistically significant. There was no significant difference in the total expression of TLR4 on macrophages before and after LA1 treatment. However, the mean flourscence indensity (MFI) of TLR4 was weaker on the LA1-treated macrophages than on the untreated macrophages. Conclusions LA1 could alleviate the DSS-induced experimental colitis in mice through suppressing the activation of TLR4 pathway on macrophages. This study provided a new insight and theoretical reference for understanding the pathogenesis of inflammatory bowel diseases.

Objective To indentify the cognitive status of Chinese patients to acne and the influencing factors to theirs' cognitive status,so as to provide solid evidences for the prevention and treatment of acne.Methods A self-designed questionnaire was made to conduct this survey of 16,156 acne patients,who seeked to the treatment in the dermatological departments from 112 hospitals in China.The survey consisted of several parts,including the general status of patients,the patients' cognition of occurrence,development and risk factors of acne,whether the first choice was seeking treatment at the hospital when the patients had acne and the condition of selection of skin care products.The factors were analyzed,which could impact the cognition of the patients' behavior of treatment,how did the patients' cognition to influence their medical behavior and skin care as well as the consistency of assessment of the severity of acne by doctors and patients themselves.Results The acne patients studied had the best knowledge of "acne is a skin disease","it not only occurs in the period of adolescence" and "the disease can be prevented and cured",which accordingly accounted for 80.65％,69.16％ and 65.49％ of the total patients respectively.However,the awareness of acne patients to heredity,high sugar and dairy products as risk factors for acne was insufficient,which accounted for 48.72％,42.40％ and 18.25％ of the total patients,respectively.Gender,age,educational level,occupation and health knowledge were the main factors affecting the cognitive level of patients;the survey also found that men,patient with educational level of junior high or even lower educational condition,occupation of labor workers or farmers and patients were lack of health education with poor knowledge of the genetics and dietary were risk factors for acne;patients with age over 36 years or with mild illness had poor knowledge of dietary risk factors for acne;the difference was statistically significant (P＜0.05).The analysis of the influence of cognitive status on medical treatment behavior and skin care showed that the better the cognition,the higher the probability of patients would choose medical treatment as the first choice as well as choosing functional skin care products;the difference was statistically significant (P＜0.05).The consistency of assessment of the severity of acne by doctors and patients was poor (Kappa value ＜0.4),and the assessment of severity of acne by patients was more serious than doctors' assessment.Conclusions Patient's cognitive status will affect their medical behavior and skin care,and there is also a phenomenon that patients have a more serious assessment of their acne condition.It is suggested that health education for acne patients should be strengthened in clinical medicine so as to improve their knowledge of acne as well as preventing from acne effectively.

Objective? To investigate the bacterial contamination of open suction tubing in intensive care units at different dwelling time and to explore the proper replacement frequency of suction tubing. Methods? The patients receiving tracheal intubation or tracheotomy in the Intensive Care Unit, Jinhua Municipal Central Hospital from November 2016 to February 2018 were selected by convenient sampling. Based on preliminary pilot experiment, totally 39 patients were selected. Samples from the internal opening of suction tubing connector at days 1, 3 and 7 were obtained for bacterial culture, and the patients' sputum was cultured as required. The type of contaminant bacteria at the internal opening of suction tubing connector was identified. The number of bacterial colony, number of bacterial genus and the consistency with patients' sputum culture at different time points were compared. Results? The bacteria at the internal opening of suction tubing connector were mainly pseudomonas aeruginosa, viridans streptococcus, baumanii and corynebacterium, which was slightly different from the findings of sputum culture. There was no statistically significant difference in the positive rate, number of bacterial colony, number of bacterial genus and the consistency with patients' sputum culture at the internal opening suction tubing connector at days 1, 3 and 7 (P＞ 0.05). Conclusions? The internal opening of open suction tubing is highly contaminated, but the bacterial contamination does not worsen over time. The suction tubing may be replaced as long as every 7 days.

In this paper, we reviewed the long history of the use of modern fresh Chinese Medicine (FCM) and summarized the development of fresh Chinese Medicine preparation (MFCMP) in recent years. Combined with domestic and foreign examples, the characteristics the technology and preparations of MFCMP are explained. Meanwhile, as for the development of FCM and MFCMPs, the problems faced and feasible solutions are put forward. Finally, based on China.s national conditions, the development trend of MFCMPs is prospected.