Objective To compare transdermal penetration of triamcinolone acetonide liposparticles (TAA-LPPs) and TAA-Ethosomes in vitro. Methods The TAA-LPPs and TAA-Ethosomes were produced and the morphology was observed by transmission electron microscope,particle size was detected by laser particle analyzer. The percutaneous permeability in vitro was tested by modified Franz diffusion pools. The amount of penetrated triamcinolone acetonide and the retention in the skin were de-termined by HPLC. Results The shape of TAA-LPPs and TAA-Ethosomes was almost spherical with mean diameter of (99. 9±1. 3) and (105±1. 4) nm, respectively. The cumulative transdermal penetration of TAA-LPPs, TAA-Ethosomess and TAA suspension was (53. 59±4. 40),(87. 03±4. 87),and (30. 54±8. 61) μg·(cm2 ) -1 , respectively . The drug retention in the skin after 32 h was (1. 02±0. 13), (0. 62±0. 08), (0. 55±0. 17) μg·(cm2 ) -1 , respectively. Conclusion TAA-LPPs is better for transdermal administration of triamcinolone acetonide by reducing systemic absorption of the drug.

Since the implementation of the new healthcare reform,it has achieved some success.However,many problems still exist in the process of primary medical reform,and there are many ethical dilemmas.The un-balanced allocation of medical resources reflects the relationship between government and market,the difficult pro-motion of " three medicine" reflects the sectoral conflicts of interest,the difficult implementation of the grading di-agnosis and treatment system reflects the different demands of stakeholders in health care system.As a result,the whole function of China's medical and health system has not been fully played.Based on the ethical perspective,this paper put forward that taking the scientific definition of government and market responsibility as a framework,it should construct an investment system of health resource allocation taking equity as a value orientation; taking ethi-cal responsibility as the framework,it should promote the cooperation consensus of the linkage reform of medical treatment,medical insurance and medical departments; and taking ethical community as the constraint,it should balance the interests of all parties and promote the implementation of the policy of grading treatment system.

Objective To analyze the problems and mechanism obstacles existing in the allocation of health human resources in medical institutions in poverty-stricken counties of Hubei province, and propose targeted policy recommendations. Methods The stratified random sampling method was used in an on-site investigation conducted at 5 county-level hospitals and 9 township hospitals in 3 poverty-stricken counties of Hubei province. Results The allocation of human resources in such counties showed an overall trend of improvement year by year. However, some of the counties still faced such problems as inadequate health workforce, unreasonable structure of health manpower, and great gaps of health manpower structure within the county. In most of the hospitals, the proportion of health technicians with bachelor's degree or above fell below 50% . In county hospitals, the proportion of personnel expenditure was generally less than 15% from 2013 to 2016. Conclusions The allocation of health human resources in poverty-stricken areas is facing such mechanism obstacles as limited financial input, restrictions of staffing quota, and lack of cooperative motivation by medical institutions. It is necessary to clarify the responsibility of the government and guarantee the fiscal support of personnel expenditure. It is also imperative to promote the reform of the personnel practice in the health system, strengthen the construction of the health talents guarantee mechanism at the primary level, optimize the vertical cooperation mechanism of medical institutions and promote the integrated health management of counties-township-villages.

Objective To observe the therapeutic effect of Ulcer-healing Decoction combined with Yijunkang enema on ulcerative colitis.Methods Twenty outpatients with ulcerative colitis were divided into experimental group and control group,and 10 patients in the experimental group were treated with Ulcer-healing Decoction combined with Yijunkang enema.The control group with 10 cases was given enema by sphindex,dexamethasone and gentamicin in combination.The changes of peripheral blood immunity protein IgG,C3 complement,erythrocyte sedimentation rate (ESR) and C-reactive protein in two groups before treatment,at 1 week,4 weeks after treatment were recorded,and the improvement time of abdominal pain,diarrhea,tenesmus feeling,stool with pus and blood and other symptoms were compared.Results There were significant differences in peripheral blood immunoglobulin IgG,C3 complement,ESR,C-reactive protein,and improvement time of abdominal pain and stool with pus and blood in two groups(P ＜0.05),but no differences were found in improvement time of diarrhea and tenesmus (P ＞ 0.05).Conclusion The combination of Ulcer-healing Decoction and Yijunkang enema has good effect on the treatment of ulcerative colitis.

Objective To observe the therapeutic effect of Ulcer-healing Decoction combined with Yijunkang enema on ulcerative colitis.Methods Twenty outpatients with ulcerative colitis were divided into experimental group and control group,and 10 patients in the experimental group were treated with Ulcer-healing Decoction combined with Yijunkang enema.The control group with 10 cases was given enema by sphindex,dexamethasone and gentamicin in combination.The changes of peripheral blood immunity protein IgG,C3 complement,erythrocyte sedimentation rate (ESR) and C-reactive protein in two groups before treatment,at 1 week,4 weeks after treatment were recorded,and the improvement time of abdominal pain,diarrhea,tenesmus feeling,stool with pus and blood and other symptoms were compared.Results There were significant differences in peripheral blood immunoglobulin IgG,C3 complement,ESR,C-reactive protein,and improvement time of abdominal pain and stool with pus and blood in two groups(P ＜0.05),but no differences were found in improvement time of diarrhea and tenesmus (P ＞ 0.05).Conclusion The combination of Ulcer-healing Decoction and Yijunkang enema has good effect on the treatment of ulcerative colitis.

Objective Toinvestigatetheeffectofmicroribonucleicacid(miRNA)-155ontwo subtypesofregulatoryTcell(Treg):inducedTreg(iTreg)andnaturalTreg(nTreg).Methods NaveT cells and nTreg were isolated from peripheral blood mononuclear cell (PBMC)of healthy donors by magnetic cell sorting. Cells were divided into 3 groups during culture,including control group (nave T cells were cultured with the presence of interleukin-2 ),iTreg group (nave T cells were cultured with the presence of interleukin-2 and transforming growth factor-β)and nTreg group(nTreg cells was cultured with interleukin-2).Each group was divided into 3 subgroups (none,scramble or miRNA-155 antagomir subgroup,3 wells in each subgroup). Expression level of miRNA-155 gene of none subgroup in 3 groups was detected by low density chip analysis method. The levels of surface marker CD25,Foxp3,CD127 of each subgroup in 3 groups were detected by flow cytometry. The percentage of CD4 +CD25 +Foxp3 +SOCS1 +Treg and suppressive function of Tregofeachsubgroupin3groupswerealsodetectedbyflowcytometry.Results Comparedwithcontrolgroup and iTreg group,the expression level of miRNA-155 was significantly lower and SOCS1 was significantly higher in nTreg group (all in P<0.05 ). After the addition of miRNA-155 antagomir,no significant change was observed in the important surface markers of Treg like Foxp3,CD25,CD127. Compared with control group and iTreg group,the expression of SOCS1 in nTreg group increased significantly (both in P <0.05 ). The expression level of miRNA-155 of none subgroup in iTreg group was lower. The expression of SOCS1 increased after the miRNA-155 was inhibited by antagomir (miRNA-155 antagomir subgroup). In iTreg group,the suppressive function of Treg in miRNA-155 antagomir subgroup was higher than that in none subgroup at the ratioof1∶8,1∶16and1∶32(allinP<0.05).Conclusions AntagonismofmiRNA-155invitrohasno significant effect on the suppression function of nTreg,but can increase the SOCS1 expression level and suppression in vitro of iTreg.

Objective To explore the impact of fast-track surgery (FTS)on prognosis of liver transplant patients.Methods Inclusion criterias:(1 )primary disease was cirrhosis or primary liver cancer meeting Milan criteria;(2)surgical method was modified piggyback orthotopic liver transplantation (OLT);(3)no liver transplantation operation was performed before.Exclusion criterias:(1 )age ≤ 1 6 years old;(2)receiving OLT more than 1 time;(3)transcatheter hepatic arterial chemoembolization or radiofrequency ablation was performed before or during operation.From January 201 1 to December 201 3 in First Affiliated Hospital of Nanjing Medical University,52 patients meeting the criteria above were enrolled into this prospective random single-blinded study (all operations were performed by same team) .According to different peri-operative managements,they were divided into FTS group (n =21 )and non-FTS (NFTS)group (n =31 ).Protocol of FTS included comprehensive pre-operative education,no bowel preparation,no usage of nasogastric tube pre-operation and surgical drainage post-operation,prevention of hypothermic during operation, smaller incision,early exercise and enhanced oral nutrition. Intra-and post-operative parameters were compared between 2 groups.Step-by-step Logistic regression was used to evaluate relationship between FTS and clinical parameters,in order to analyze the impact of FTS on the prognosis of liver transplantation.Results Compared with NFTS group,operation time and anhepatic phase time decreased significantly in FTS group,as well as intra-operative bleeding and transfusion (all in P <0.05).Besides,intensive care unit (ICU)days and total length of stay in FTS group were shorter than those in NFTS group,which indicated a better prognosis of patients in FTS group (both in P <0.05 ).Logistic regression suggested that FTS management was a favorable factor of shortening ICU days (odds ratio:0.301 ,95% confidence interval:0.1 84-0.494,P =0.000)and total length of stay (odds ratio:0.1 48,95% confidence interval:0.085-0.257,P =0.000).Conclusions Application of FTS in perioperative period can improve the prognosis of liver transplant patients.

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Temporary cardiac pacing is an essential technique in the diagnosis and treatment of arrhythmias. Due to its urgency, complexity, and uncertainty, it is necessary to develop an evidence-based emergency operation norms. Currently, there is no specific consensus guidelines at home or abroad. The Emergency Branch of Chinese Medical Association organized relevant experts to draft the Chinese emergency expert consensus on bedside temporary cardiac pacing (2023) to guide the operation and application of bedside cardiac pacing. The formulation of the consensus adopts the consensus meeting method and the evidentiary basis and recommendation grading of the Oxford Center for Evidence-based Medicine in the United States. A total of 13 recommendations were extracted from the discussion on the methods of bedside temporary cardiac pacing, the puncture site of transvenous temporary cardiac pacing, the selection of leads, the placement and placement of leads, pacemaker parameter settings, indications, complications and postoperative management. The recommended consensus includes the choice between transcutaneous and transvenous pacing, preferred venous access for temporary transvenous pacing, the target and best guidance method for implantation of bedside pacing electrodes, recommended default pacemaker settings, recommended indications for sinoatrial node dysfunction, atrioventricular block, acute myocardial infarction, cardiac arrest, ventricular and supraventricular arrhythmias. They also recommended ultrasound guidance and a shortened temporary pacing support time to reduce complications of temporary transvenous cardiac pacing, recommended bedrest, and anticoagulation after temporary transvenous pacing. Bedside temporary cardiac pacing is generally safe and effective. Accurate assessment, correct selection of the pacing mode, and timely performance of bedside temporary cardiac pacing can further improve the survival rate and prognosis of related emergency patients.
Humans ; Cardiac Pacing, Artificial/methods* ; Pacemaker, Artificial ; Arrhythmias, Cardiac/therapy* ; Myocardial Infarction/therapy* ; Electrodes

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.