Objective To evaluate the diagnostic value of T-cell enzyme-linked immunosorbent spot assay (T-SPOT.TB) using both pleural effusion and peripheral blood in tuberculous pleurisy.Methods One hundred and two cases of in patients with pleural effusion treated in Anhui Chest Hospital from January 2014 to October 2015 were enrolled in this study.T-SPOT.TB was performed using both serous effusion mononuclear cells (SEMC) and peripheral blood mononuclear cells (PBMC),and the diagnostic sensitivity and specificity were calculated.Chi square test was used for categorical variables and MannWhitney U test was used for continuous variables in non-normal distribution.Results Of the 102 participants,71 (69.61 ％) were microbiologically or clinically diagnosed with tuberculous pleurisy and 31 (30.39 ％) were diagnosed with other diseases.In tuberculous pleurisy group,the median spot forming cells (SFC) of T-SPOT.TB for early secretory antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) using SEMC were 159/2.5 × 105 (120/2.5 × 105-200/2.5× 105) and 160/2.5 × 105 (110/2.5 × 105-210/2.5 × 105),respectively;and the median SFC of T-SPOT.TB using PBMC were 30/2.5×105 (15/2.5×105-55/2.5×105) and 40/2.5×105(8/2.5×105-87/2.5 ×105),respectively.The SFC counts of SEMC were obviously higher than those of PBMC,and differences were statistically significant (for ESAT-6,Z=-7.818;for CFP-10,Z=-7.120,both P＜0.05).The ROC curve analysis showed that using a cut-off value of 38 SFC per 2.5 × 105 SEMC,the area under the curve is 0.969.The sensitivity and specificity of T-SPOT.TB using PBMC were 90.14％ and 77.42％,respectively;and those of T-SPOT.TB using SEMC were 95.77％ and 93.55％,respectively.When combined the T-SPOT.TB assay using both PBMC (≥6 spots) and SEMC (≥38 spots),the sensitivity and specificity were 90.14％ and 96.77％,respectively.Conclusion The joint detection of T-SPOT.TB using both PBMC and SEMC can be an effective diagnostic method for tuberculous pleurisy.

Objective To explore the effects of comprehensive restraint reduction program on preventing un-planned extubation among ICU patients with tracheal intubation. Methods Totally 266 cases of ICU patients with tracheal intubation in our hospital were selected as the research objects using the convenient sampling method.They were divided into two groups by time: the experimental group of 130 cases implementing a comprehensive reduction constraint program and the control group of 136 cases using conventional physical restraint in nursing process.The constraint rate, constraint length, UEX incidence, skin and satisfaction of the two groups were compared. Results In the experimental group, the rate of physical restraint and UEX decreased, the average restraint length of each patient was shortened, skin integrity at the site of restraint improved, and the satisfaction of patients increased. Compared with the control group, the differences were statistically significant(P<0.01 or P<0.05). Conclusion The com-prehensive restraint reduction program can reduce the rate of physical restraint and the incidence of unplanned ex-tubation among ICU patients with tracheal intubation.

Objective To evaluate diagnostic value of CT coronal scan to foreign body in bronchus of children.Methods 30 cases appearances of CT coronal scan to foreign body in bronchus of children were analysed.The appearances between CT coronal scan and axial scan,X-ray examination of chest were contrasted in some cases.Results Foreign body in bronchus or granuloma around part of foreign body were shown clearly by CT coronal scan in 30 cases,28 cases obstructive emphysema,13 cases obstructive pneumonia and 3 cases obstructive atelectasis were also shown clearly.Another,CT coronal scan showed the double margin sign of 16 cases diaphragm and 11 cases mediastinum.Conclusion CT coronal scan could show direct and indirect signs of the most foreign body in bronchus of children and it may be acte as primary examintion.

Objective: To investigate the usage of medical and health care APP among female college students, and to understand possible influencing factors, so as to provide reference for medical health care behaviors and personal health among college students. Methods: A stratified random sampling method was used to select 891 female college students from 3 colleges in Weifang. A questionnaire survey on their concentration on their own health, the knowledge, cognition and behavior of medical and health care APP, and Logistic regression analysis was used to analyze the influencing factors. Results: There were 55.4% female college students who had used medical and health care APP, and most of them (290) had used fitness and weight loss APP. There was statistical significance of the different usages of students of different degrees, majors and grades(χ2=26.55, 7.72, 13.96, P<0.05). Logistic regression analysis showed that educational background, annual medical costs, awareness of medical and health care APP and attitude towards APP prospect were the factors influencing the utilization of medical and health care APP (OR=0.44，0.69，1.36，1.23，P<0.05). Conclusion The usage rate of medical and health care APP is general, and sustained utilization rate is low, the APP should enrich menstrual period consumption and figure report, add video recommendation, interactive dating, and other functions, improve female students medical and health care APP cognition, female college students to change health care APP attitude.

Family physicians contracted service is an important choice to deepen the reform of China′s healthcare reform and achieve the strategic goal of " health for all" . In order to effectively promote the contracted service, the central government has successively issued a number of policy documents, which are echoed by the localities in their proactive explorations, achieving remarkable results. But there are also multiple roadblocks hindering the contracted service to progress. This article referred to the three-circle theory and studied policy implementation from the three dimensions of policy value, policy resources, and policy impetus. A thorough analysis of the problems in the implementation process revealed such main problems as insufficient family physicians, inadequacy of supporting policies and low level of policy acceptance among the young healthy age groups. The follow-up work will promote the long-term implementation of the family physicians contracted service policy by enriching the family physicians team, enriching supporting policies, and focusing on promotions to key age groups.

Bruton tyrosine kinase (BTK) is a key mediator of B-cell receptor signalling cascade and an effective target for treating mantle cell lymphoma (MCL). BTK inhibitors play a critical role in the treatment of MCL. Here we introduced the mechanism of action of BTKI in the treatment of MCL. Though generally well prescribed, Ibrutinib, as the first BTKI, still has limitations of toxicity and resistance. New BTK inhibitors, such as zanubrutinib, acalabrutinib and orelabrutinib, are designed to improve on the safety and efficacy as first-generation BTK inhibitors. Comparing the similarities and differences of the two generations of BTKI in structure and function provides a basis for better clinical application of BTKI. On November 15, 2019, FDA approved zanubrutinib for marketing for patients with adult mantle cell lymphoma. Compared with Ibrutinib, zanubrutinib was found with higher target selectivity, longer-lasting inhibition, fewer adverse reactions, and better patient benefit. Zanubrutinib provides a viable treatment option for patients with r/r MCL. At the same time, it is also actively carrying out clinical researches on the treatment of other B-cell lymphomas. It is a very promising targeted drug.

Objective:To evaluate the value of preoperative prediction of vessel invasion (VI) of locally advanced gastric cancer by machine learning model based on the venous phase enhanced CT radiomics features.Methods:A retrospective analysis of 296 patients with locally advanced gastric cancer confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from July 2011 to December 2020 was performed. The patients were divided into VI positive group ( n=213) and VI negative group ( n=83) based on pathological results. The data were divided into training set ( n=207) and test set ( n=89) according to the ratio of 7∶3 with stratification sampling. The clinical characteristics of patients were recorded, and the independent risk factors of gastric cancer VI were screened by multivariate logistic regression. Pyradiomics software was used to extract radiomic features from the venous phase enhanced CT images, and the minimum absolute shrinkage and selection algorithm (LASSO) was used to screen the features, obtain the optimal feature subset, and establish the radiomics signature. Four machine learning algorithms, including extreme gradient boosting (XGBoost), logistic, naive Bayes (GNB), and support vector machine (SVM) models, were used to build prediction models for the radiomics signature and the screened clinical independent risk factors. The efficacy of the model in predicting gastric cancer VI was evaluated by the receiver operating characteristic curve. Results:The degree of differentiation (OR=13.651, 95%CI 7.265-25.650, P=0.003), Lauren′s classification (OR=1.349, 95%CI 1.011-1.799, P=0.042) and CA199 (OR=1.796, 95%CI 1.406-2.186, P=0.044) were independent risk factors for predicting the VI of locally advanced gastric cancer. Based on the venous phase enhanced CT images, 864 quantitative features were extracted, and 18 best constructed radiomics signature were selected by LASSO. In the training set, the area under the curve (AUC) of XGBoost, logistic, GNB and SVM models for predicting gastric cancer VI were 0.914 (95%CI 0.875-0.953), 0.897 (95%CI 0.853-0.940), 0.880 (95%CI 0.832-0.928) and 0.814 (95%CI 0.755-0.873), respectively, and in the test set were 0.870 (95%CI 0.769-0.971), 0.877 (95%CI 0.788-0.964), 0.859 (95%CI 0.755-0.961) and 0.773 (95%CI 0.647-0.898). The logistic model had the largest AUC in the test set. Conclusions:The machine learning model based on the venous phase enhanced CT radiomics features has high efficacy in predicting the VI of locally advanced gastric cancer before the operation, and the logistic model demonstrates the best diagnostic efficacy.

Objective:To explore the contents and methods of clinical comprehensive evaluation of microecologics, with the example of Bifidobacterium quadruple viable tablet, in order to provide evidence for clinical rational use of microecologics, and microecologics research, development and related decision-making, and to promote rational use of medications. Methods:Based on the research data collected from systematic literature search, health technology assessment methods such as evidence-based medicine and pharmacoeconomics evaluation were used to estimate the safety, efficacy, economics, suitability, accessibility and innovation of Bifidobacterium quadruple viable tablet. Results:In terms of efficacy, Bifidobacterium quadruple viable tablet showed significant therapeutic effects in the treatment of pediatric diarrhea, antibiotic-related diarrhea, diarrhea-predominant irritable bowel syndrome, and secondary diarrhea caused by diseases such as ulcerative colitis, as well as constipation and functional dyspepsia. It can also be used in the treatment of various diseases such as Helicobacter pylori related gastritis, liver cirrhosis, non-alcoholic fatty liver disease. In terms of safety, the incidence of adverse effects of this medication was low, and most were mild to moderate and transient symptoms. In terms of economics, compared with mesalazine alone in the treatment of ulcerative colitis, the incremental cost-effectiveness ratio of combination of Bifidobacterium quadruple viable tablet and mesalazine was 1 743.2. Besides, the daily treatment cost of Bifidobacterium quadruple viable tablet was lower than that of combination of Bifidobacterium triple viable and Bacillus licheniformis (1.87 to 2.80 yuan vs. 2.08 to 5.78 yuan). In terms of innovation, this medication had multiple patents and had been identified as a high-tech product in Zhejiang Province. In terms of suitability, the overall suitability of use and technical characteristics of medication were good. It could be further improved in the aspects of dosage form and system. In terms of accessibility, the price of the medication was stable, affordable and accessible to the general public. Conclusions:Based on the existing evidence, Bifidobacterium quadruple viable tablet presented effective with supported evidences, good safety, accessibility and innovation. The suitability can be further optimized. However, more in-depth and targeted research is needed in terms of economics and innovation in different clinical applications, and there is space for optimization in medication suitability.

Objective:To explore the association between the frequency of using smoking cessation application (APP) and the effect of smoking cessation in smoking cessation clinic.Methods:A clinical trial with a non-randomized controlled design was conducted in the smoking cessation clinic of China-Japan Friendship Hospital from July 2019 to June 2021. Participants were given a comprehensive smoking cessation intervention of mobile APP combined with bupropion. The primary outcome measures were carbon monoxide validated sustained abstinence at 9-12 weeks.Results:A total of 187 participants were included in the final analysis. After 12-week intervention, the sustained abstinence at 9-12 weeks was 42.2%. For the frequency of APP use, 20.9% (39/187) of the participants used it≥6 days per week, 62.0% (116/187) used it 2-5 days per week, and 17.1% (32/187) used it≤1 day per week. Multivariate analysis showed that smoking cessation rate was associated with smoking duration, cigarettes smoked per day and frequency of APP use. Participants with higher frequency of APP use had a higher likelihood of quitting smoking ( OR=4.95, 95% CI: 1.32-18.63). Conclusion:The increased frequency of mobile smoking cessation APP use is associated with higher probability of quitting smoking in smoking cessation clinic.

Objective:To study the willingness of the medical staff of tertiary hospitals to be dispatched to work for a long time at the district hospitals under the " municipal trusteeship of district-ownership hospitals" mode, and explore the key factors that affect their long-term willingness, for references of optimizing the incentive system of the model.Methods:A questionnaire was designed as guided by the two-factor theory. In May 2019, a typical sample survey was made to investigate 103 medical staff of two tertiary hospitals in Beijing on their willingness to be dispatched to hospitals of district ownership. The survey covered such aspects as their basic personal information, hygiene factors(family responsibility, interpersonal connections expansion, mobilization and encouragement of leaders, etc.), and incentive factors(personal career development, greater potential giving play to their own talents, self-achievement, etc.). Descriptive analysis and univariate hypothesis testing were used to compare the differences of the dispatch willingness of staff of different characteristics. Meanwhile, an ordinal multinomial logistic regression model was built to analyze the influence factors of long-term dispatch willingness of these staff along with individual in-depth interviews.Results:The medical staff when they were dispatched to work at the entrusted hospitals for a long time, were concerned mostly with top six factors. These factors refered to a reasonable incentive(rewards)mechanism, family responsibility, colleague evaluation of the entrusted hospital, interpersonal connections expansion, personal career development, and potential unlocking. Those staff with dispatch experience had higher willingness to be dispatched than those without( P <0.05). The former saw higher of their personal career development resulting from the dispatch(3.91 points), while the latter saw higher their post-dispatch salary incentive mechanism(3.95 points). Compared with common medical staff, medium and high level management staff were more willing to be dispatched for a long time( H=14.536, P<0.001). Leadership mobilization in hygiene factors and personal career development in incentives factors were the key drivers for the long-term willingness of medical staff to be dispatched( P<0.05). Conclusions:The willingness of medical staff to be dispatched for a long time needs to be strengthened in the " municipal trusteeship of district-ownership hospitals" mode. Managers of the district-ownership hospitals should take into full consideration, the needs of different categories and levels of medical staff dispatched, guarantee the remuneration and performance pay of these staff, and enable their career track planning, hence mobilizing their incentives, and increase their willingness to work at such hospitals for a long time.