OBJECTIVE To analyze the factors affecting the inclusion of Chinese patent medicines in China’s National reimbursement drug list （NRDL）， and assist these medicines in fully reflecting their actual value in the reimbursement admission process. METHODS From the official website of the China’s National Healthcare Security Administration， the application materials of Chinese patent medicines outside the list that passed the formal review from 2021 to 2023 were obtained， including basic information on the medicines， safety， efficacy， innovation and heritage information， and supplemented with references from the pharmacopeia and the Yaozhi Database. Economic information and enterprise information were obtained through websites such as the Yaozhi Database. Univariate analysis， multivariate Logistic regression analysis and stepwise regression analysis were conducted on the initial application information and admission outcomes of the medicines. Sensitivity analysis was also performed on medicines that applied multiple times in different years as independent samples. RESULTS & CONCLUSIONS There were 27 Chinese patent medicines that passed the formal review from 2021 to 2023， involving 37 applications. The univariate analysis results showed that medicines with descriptions of traditional Chinese medicine （TCM） syndrome types， clear adjustment information for medication plans for specific population groups， short time to market in the indications of the package insert， registered as Class 1 to 6 following or class Ⅰ innovative TCM/class Ⅲ ancient classic prescription compound TCM registered， and those produced by enterprises listed in the “Top 100 Chinese Pharmaceutical Industry Enterprises” list for the current year were more likely to be included in the NRDL （P＜0.05）. The results of the multivariate Logistic regression analysis were not statistically significant， but the stepwise regression results indicated good consistency with the univariate analysis. The results of the sensitivity analysis were consistent with the trend of basic analysis. It is recommended that Chinese patent medicine enterprises further clarify the description of product instructions， expand innovation capabilities， inherit and develop ancient classic prescriptions， and promptly complete clinical trial evidence.

Objective:To study the safety and efficacy of hiatal hernia-endoscopic submucosal dissection (HH-ESD) for the treatment of giant hiatal hernia (>3 cm in length) complicated with refractory gastroesophageal reflux disease (GERD).Methods:Patients with giant hiatal hernia complicated with refractory GERD who voluntarily received HH-ESD at the Digestive Endoscopy Center of the Affiliated People's Hospital of Inner Mongolia Medical University from April 2018 to March 2020 were included in the clinical study. The completion of HH-ESD and the occurrence of complications were observed, and the changes of indicators before and after the treatment were observed, including gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, gastroesophageal reflux disease questionnaire (GERD-Q) score, endoscopy results, 24 h esophageal pH monitoring results, esophageal high-resolution manometry results and proton pump inhibitor (PPI) usage.Results:Data of 10 patients were collected during the study, with a medical history of 2-10 years. All patients successfully underwent HH-ESD treatment. No adverse events such as perforation and massive bleeding occurred during the operation, and the hospital stay was 6-12 days. Dysphagia occurred in 3 cases after the operation, which was relieved spontaneously within 3 or 6 months. The preoperative GERD-HRQL scores ranged from 19 to 29, which were reduced to 0-14 and 0-8 at 3 and 12 months after the operation, respectively. The preoperative GERD-Q score was 9-17, and the scores at 3 and 12 months after the operation were all 6-9, which were significantly lower than those before. Gastroscopy showed that esophagitis was improved in all patients, hernia sac was reduced, and Hill grade was reduced compared with that before. The preoperative DeMeester score was 30.3-247.1, and the postoperative 12-month score was 0.2-29.9, which was significantly lower than that before. The long diameter of hiatal hernia was 3.0-6.0 cm before the operation and 0-5.0 cm at 12 months after, which was smaller than that before. At 12 months of the follow-up, 7 patients had stopped PPI, and the remaining 3 had changed to intermittent oral PPI.Conclusion:Preliminary results show that HH-ESD is safe and effective for the treatment of giant hiatal hernia complicated with refractory GERD.

Objective To study the safety and efficacy of peroral endoscopic cardial constriction (PECC) for gastroesophageal reflux disease (GERD). Methods A total of 27 patients with GERD who visited the Affiliated Hospital of Inner Mongolia Medical University from August 2016 to December 2017 and met the inclusion criteria received PECC. The 24 h esophageal pH-resistance monitoring ( DeMeester ) scores, GERD health-related quality of life ( GERD-HRQL ) scores, GERD-questionnaires ( GERD-Q ) symptom scores and clinical efficacy before and after operation were compared. Results DeMeester score at 3 months ( Z=-6. 940, P=0. 001) and 6 months ( Z=-6. 307, P=0. 001) after treatment, GERD-HRQL score at 3 months ( t=11. 499, P=0. 001) and 6 months ( t=10. 959, P=0. 001) as well as GERD-Q symptom score at 3 months ( t=30. 647, P=0. 001) and 6 months ( t=27. 217, P =0. 001) after surgery significantly decreased, compared with those before. The curative rates were 81. 5％ ( 22/27) and 77. 8％(21/27) at 3 months and 6 months after operation. Conclusion PECC, a new method for the treatment of GERD with good short-term effect, safety and feasibility,can be recommended for clinical application.

Objective To investigate the current status and influencing factors of self-efficacy for oral self-care in patients with chronic periodontitis. Methods A total of 357 patients with chronic periodontitis were investigated with the self-designed questionnaire, Self-Efficacy Scale for Self-care (SESS), Dental Fear Scale(DFS) and Medical Coping Modes Questionnaire(MCMQ). Results The total score of SESS was(58.66±7.27)points,which was at the medium level.In the scores of each dimension, self-efficacy for dietary habits was the highest,(20.42 ± 2.88)points,and self-efficacy for brushing of the teeth was the lowest,(18.37 ± 2.94)points.Multiple linear regression analysis showed that age,dental fear and medical coping mode were influencing factors of self-efficacy for oral self-care,which explained 53.6% of the variance. Conclusions Medical staff should pay more attention to the patients who are in low level of self-efficacy for self-care.Oriented by each dimension and influencing factors,specific psychological intervention should be given to reduce dental fear,improve medical coping style,enhance the level of self-efficacy for oral self-care and promote oral self-care behaviors and somatopsychic health.

Objective To demonstrate the imaging characteristics of pancreatic neuroendocrine neoplasm (P-NEN).Methods The CT and MRI findings of 43 cases of P-NEN confirmed by pathology were analyzed,and compared with pathological results.Results Mean size of 43 lesions in 43 P-NEN patients were (25.00± 1.82)mm.Necrosis cystic degeneration were found in 26 lesions.In CT plain scan,15 lesions were isodense,28 lesions were hypodense.All of 43 lesions were hypointensity signal on T1WI;27 lesions were hypointensity signal,16 cases were isointensity signal on T2WI.Twenty-seven lesions showed envelope;30 lesions showed clear outline.In enhancement images,24 lesions were marked enhancement since arterial phase;8 lesions showed delayed enhancement;5 lesions showed centrality enhancement;6 lesions showed wild enhancement.Conclusion P-NEN has some characteristics on CT and MRI scanning,imaging can play an important role in diagnosis for P-NEN.

The copy numbers of exogenous gene in transgenic animals is always regarded as an important information of transgenic animals.Thus,simple and sensitive methods are required for the detection of the copy numbers of exogenous gene.Three kinds of transgenic Shanbei white cashmere goats,containing Tβ4-GFP,FGF5s-GFP and VEGF164-GFP,has been obtained by using PiggyBac(PB) transposon system.Fluorescence quantitative PCR was carried out to detect the copy numbers of copGFP.Using Gluc as reference gene,the double standard curves of exogenous gene and reference gene were mapped and the genomic DNA of transgenic goats were analysized by real-time fluorescence quantitative PCR.Moreover,the copGFP/Gluc ratio in the samples was calculated as the copy numbers of copGFP.In addition,Tβ4-GFP transgenic cashmere goats were selected to detect the integration sites by using the genomic walking kit.The results showed that the standard curve equation of copGFP was y=-3.230 6x+39.216 (R2 =0.998 8) and the standard curve equation of Gluc was y=-3.564 8x+38.440 (R2 =0.996 0).The copy numbers of exogenous gene in the transgenic cashmere goats were obtained and the numbers of integration sites in the selected Tβ4-GFP transgenic goats were consistent with the copy numbers of copGFP.As a conclusion,the high throughput,fast and sensitive real-time fluorescence quantitative PCR is an efficient and convenient method for the copy number of exogenous gene in transgenic cashmere goats.

BACKGROUND:Proximal humeral fracture fixation can provide a more stable fixation, has a stronger biomechanical stability, but open reduction and fixation wil cause extensive soft tissue dissection and heavy damage to the rotator cuff. Closed wear nail has a high failure rate of fixation, fracture re-displacement and other defects. OBJECTIVE:To investigate the technical methods of applying closed reduction, percutaneous pinning anatomical external fixation in repair of proximal humeral fracture, and to analyze the application characteristics and safety in different types of proximal humerus fractures. METHODS:Based on the special anatomical structure of proximal humerus, a shoulder external fixator has been independently researched and developed by author. The clinical data of 23 patients treated with closed reduction and percutaneous pinning anatomical external fixation (homemade) because of proximal humerus fracture at the Department of Traumatology, Tianjin Hospital during March 2010 to March 2014 were retrospectively analyzed. In accordance with Neer classification type, there were 19 cases of 2-part fractures of the humerus, 4 cases of 3-parts fractures of the humerus, with greater tuberosity avulsion fractures, which were al fresh fractures and were treated with closed reduction pinning and external fixation. Regular fol ow-up was conducted after treatment. Radiographic assessment, pain and function evaluation were conducted during fol ow-up, so as to work out the functional recovery, determine the final repair result. RESULTS AND CONCLUSION:Al patients were fol owed up for 6-24 months. Total y 23 patients initial y healed in fracture within 8 weeks. After treatment, visual analogue pain score of patients was 0.8 points. In the final fol ow-up, the American Shoulder and Elbow Surgery Association of shoulder function scoring system (ASES) score was an average of (91.7±2.6) points, Constant shoulder function score was an average of (88.3±4.7) points, the University of California (UCLA) shoulder joint scoring system score was (31.9±3.1) points, simple shoulder test (SST) system score was an average of (9.6±2.4) points. The shoulder function assessment (UCLA score) of these 12 patients was excel ent, of 9 cases was good, and of 2 cases was poor. The excel ent rate reached 91%after treatment. These results suggest that the application of closed reduction, percutaneous nailing anatomical external fixation in repair of proximal humerus fractures has the features of stable fixation, and smal damage of soft tissue. Standardizing the angle of closed nailing and entrance point, fixing from the intersection of three planes in arcuate-shape and connecting with external fixation can achieve a more stable fixed effects.

Syl948 is a synthesized selective S1P1 agonist with novel structure. HTRF-IP1 test indicated that Syl948-P, the active form of Syl948 in vitro, has strong activity against S1P1 (EC50: 83 +/- 16 nmol x L(-1)), but its effect on S1P3 was very weak (EC50: 1 026 +/- 90 nmol x L(-1)). In SD rats, oral administration of Syl948 10 mg x kg(-1) significantly decreased the peripheral blood lymphocytes (PBL), with the maximal PBL inhibition rate of 63%, which was as similar as equal dose of fingolimod (FTY720). Oral administration of Syl948 10 mg x kg(-1) had no effect on heart rate of SD rats, which was better than FTY720. Daily oral administration with Syl948 (2 or 4 mg x kg(-1)) significantly prolonged the survival time of the allografts of skin slice on mice. In summary, the above results demonstrated that Syl948 has great selectivity in vitro and good activity in vivo, which indicated its potential use as an anti-rejection drug in skin transplantation.

Aim To determine the effect of SYL934 , a novel immunosuppressant, on skin allograft rejec-tion. Methods HTRF-IP1 assay was used to evaluate the agonistic activity of SYL934-P, the active form of SYL934 in vivo, on S1P1 and S1P3 in vitro. SD rat peripheral blood lymphocytes ( PBL ) test and heart rate test was used to assess the in vivo immunosuppres-sive effect and heart rate effect of SYL934 . Mice skin graft transplantation experiment was used to observe the effect of SYL934 on skin allograft refection. ResultsSYL934-P selectively activated S1 P1 but not S1 P3 in vitro. Single orally administration of SD rats with
SYL934 decreased the PBL significantly and played an obviously immunosuppressant role, but did not affect the heart rate. Daily orally administration of mice with SYL934 significantly increased the survival rate of al-lografts of skin slice in mice. Conclusion SYL934 has great selectivity in vitro and good activity in vivo, which indicated it potential use as an anti-rejection drug in skin transplantation.

In the elderly, patient who suffered from hip fracture need to stay in bed for a long time and has a higher prevalence of complications and mortality. Considering the factors of patients in the intraoperative death and postoperative re?habilitation, we take appropriate treatment measures during preoperative, intraoperative and postoperative period respective?ly based on the concept of Enhanced Recovery. Patient will benefit from rapid rehabilitation and reduction of incidence of complications and mortality. ERAS includes preoperative fasting, preventive anagelsia, intraoperative temperature control, anesthesia and surgical approach, postoperative intravenous restriction, nutritional support and painless early motion. This ar?ticle intends to review the security , reliability and clinic efficacy of ERAS.