Objective To investigate doctor's screening practice for hepatitis B virus (HBV) infection before immunosuppressive therapy for rheumatoid arthritis (RA) patients and clinical management of RA patients with positive surface antigen of HBV (HBsAg).Methods One hundred fifty doctors who treated RA patients in daily clinic were survied with a modified American College of Rheumatology (ACR) questionnaire which was composed of demographic data and 10 multiple-choice questions.Step-forward logistic regression analysis was performed to find out the influencing factors,then receiver operator characteristic curve analysis and area under the curve were performed to confirm the influencing factors.Results One hundred and thirtytwo effective questionnaires were collected.Before immunosuppressive therapy,HBV screening rate in outpatients with RA was significandy lower than that in hospitalized patients (68.7％ vs 94.6％,x2=31.5,P＜0.01).Only 23.7％(31/131) of doctors considered antiviral treatment for all RA patients with positive HBsAg.One hundred and thirteen doctors had clinical experience of antiviral treatment,but only 30.1％(34/113) and 23.9％ (27/113) of these doctors chose entecavir or adefovir as the antiviral drug respectively,59.3％ (67/113) prescribed antiviral drug before or together with immunosuppressive therapy compared with 40.7％(46/113) after HBV reactivation.Only 20.4％(23/113) of doctors would sustain antiviral treatment until the termination of steroid or disease modifying antirheumatic drugs (DMARDs).During immunosuppressive therapy for HBsAg(+) RA patients,11.4％(15/132) and 30.3％(40/132) of doctors reported no regular monitoring of aminotransferase or HBV DNA respectively.Conclusion Our survey shows that HBV screening rate in outpatients with RA is low and low awareness of antiviral treatment for all RA patients with positive HBsAg,and lack of awareness of indication,choosing of antiviral drugs,initiation,monitoring and duration of antiviral treatment during immunosuppressive therapy.Further medical education on the associated information and importance to collaborate with hepatologists should be emphasized.

Objective:To explore the therapeutic law of moxibustion in Professor Zhou Meisheng's medical manuscripts for epidemic hemorrhagic fever (EHF) based on data mining and knowledge map technology.Methods:The manuscript data of Professor Zhou Meisheng's moxibustion treatment of EHFwere collected from Infectious Diseases Department of Dangshan County People's Hospital from December 16, 1985 to December 25, 1987. Graphpad Grism 8.0 software was used for descriptive analysis. PHP 5.4 program code was used for association rule analysis. SPSS Statistics 26.0 was used for clustering analysis. Neo4j Community 3.5.25 database was used to analyze the syndrome-weight graph.Results:205 prescriptions were included. There were 21 symptoms with frequency>40, in which the frequency of aversion to cold, fever, rash and irritability was 100%. The main types of moxibustion methods used in the treatment included moxibustion frame fumigation moxibustion, Wanying acupoint moxibustion pen moxibustion, and fire needle instead of moxibustion. There were 29 acupoints with a frequency of >25, including Zhongwan (CV12), Shenshu (BL23) and Mingmen (DU4), etc. Association rules showed that Sanyinjiao (SP6)-Zhongwan (CV12)-Feishu (BL13)-Shenshu (BL23)-Zhiyang (DU9) had the highest correlation. Six effective clustering combinations of moxibustion for EHF were summarized by clustering analysis. The weight graph can obtained the first 30 relationships with high correlation of target syndromes.Conclusions:Professor Zhou applied the idea of "moxibustion for heat syndrome" to the treatment of EHF, and took the method of "acupoint selection according to symptoms" as the main acupoint selection idea for moxibustion treatment of EHF. In clinical practice, moxibustion combined with auxiliary operation of TCM is often used to treat EHF, which can achieve good results.

To explore the mode of"one-day outpatient"based continuous management and examine its feasibility and preliminary effects for improving menopausal syndrome and mood among menopausal women.Clinical intervention study was conducted in Obstetrics and Gynecology Center of the Third Affiliated Hospital of Chongqing Medical University from May 2020 to May 2021.The continuous management mode of "one-day outpatient service" for menopause was constructed in terms of multidisciplinary resources, including offline "one-day outpatient" health education, online 7-week group continuous intervention on "healthy lifestyle" and offline half-day focus group interview. Pre-and post-scores of the modified Kupperman scale and the positive/negative emotional scale (PANAS) were measured to compare the status of menopausal syndrome and emotional experience of Seventy-eight female participants (40-60 years old), meanwhile, before and after comparison of the blood lipid and body composition indexes of participants were also performed. Paired t test or Wilcoxon signed rank test were used.Results show that the pre-and post Kupperman scores were 14.65±8.51 vs 10.26±5.83 ( t=-5.59, P<0.01), and the positive emotional scores (pre- 28.53±5.85 vs post- 30.13±6.30) were improved ( t=2.59, P=0.012) and negative emotional scores [pre- 20.5(10) vs post- 17.0(7)] were decreased ( Z=-5.09, P<0.01). The triglyceride level of participants declined from (1.27±0.54) mmol/L to (1.09±0.38) mmol/L ( t=-2.45, P<0.05). In addition, the body mass index(pre- 22.52±2.34 vs post- 22.06±2.22), percentage of body fat (pre- 31.72±6.22 vs post- 30.91±6.52)and Visceral fat area(pre- 83.96±30.26 vs post- 79.66±29.71) were all improved ( t=-3.58, t=-2.57, t=-2.59, P<0.05). Therefore,the mode of"one-day outpatient"based continuous management can effectively improve menopausal syndrome and adverse mood, reduce patients′ blood lipid, improve the body composition, and maybe contribute to the prevention of long-term chronic diseases.

To explore the mode of"one-day outpatient"based continuous management and examine its feasibility and preliminary effects for improving menopausal syndrome and mood among menopausal women.Clinical intervention study was conducted in Obstetrics and Gynecology Center of the Third Affiliated Hospital of Chongqing Medical University from May 2020 to May 2021.The continuous management mode of "one-day outpatient service" for menopause was constructed in terms of multidisciplinary resources, including offline "one-day outpatient" health education, online 7-week group continuous intervention on "healthy lifestyle" and offline half-day focus group interview. Pre-and post-scores of the modified Kupperman scale and the positive/negative emotional scale (PANAS) were measured to compare the status of menopausal syndrome and emotional experience of Seventy-eight female participants (40-60 years old), meanwhile, before and after comparison of the blood lipid and body composition indexes of participants were also performed. Paired t test or Wilcoxon signed rank test were used.Results show that the pre-and post Kupperman scores were 14.65±8.51 vs 10.26±5.83 ( t=-5.59, P<0.01), and the positive emotional scores (pre- 28.53±5.85 vs post- 30.13±6.30) were improved ( t=2.59, P=0.012) and negative emotional scores [pre- 20.5(10) vs post- 17.0(7)] were decreased ( Z=-5.09, P<0.01). The triglyceride level of participants declined from (1.27±0.54) mmol/L to (1.09±0.38) mmol/L ( t=-2.45, P<0.05). In addition, the body mass index(pre- 22.52±2.34 vs post- 22.06±2.22), percentage of body fat (pre- 31.72±6.22 vs post- 30.91±6.52)and Visceral fat area(pre- 83.96±30.26 vs post- 79.66±29.71) were all improved ( t=-3.58, t=-2.57, t=-2.59, P<0.05). Therefore,the mode of"one-day outpatient"based continuous management can effectively improve menopausal syndrome and adverse mood, reduce patients′ blood lipid, improve the body composition, and maybe contribute to the prevention of long-term chronic diseases.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

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.