OBJECTIVE To provide empirical basis for promoting the dynamic adjustment of the pharmaceutical care catalogue and the formulation of policies such as hierarchical payment of medical insurance. METHODS A multicenter cross- sectional survey method was adopted to conduct a questionnaire survey among 424 inpatients in 22 tertiary medical institutions in 12 prefecture-level cities of Hubei Province to evaluate their demand for pharmaceutical care， willingness to pay and preference for service forms. Combined with univariate and multivariate Logistic regression analysis， the influencing factors and key factors that affect patients’ willingness to pay for pharmaceutical care were identified. RESULTS Only 39.86% of the patients were aware of pharmaceutical care or pharmacists， and 89.62% of the patients hope to receive pharmaceutical care. Among the 16 types of pharmaceutical care， the patients surveyed had a relatively high recognition rate for guidance on drug usage and dosage， notification of medication precautions， and the identification， prevention and handling of adverse drug reactions. 96.70%， 95.30%， and 94.12% respectively expressed strong approval and approval. The demand for services such as insurance-related policy consultation， popular science on the mechanism of drug action， and assessment of the combined use of traditional Chinese and Western medicines was relatively low， with 61.65%， 68.47%， and 68.47% expressing strong approval and approval respectively. The positive influencing factors of willingness to pay were household monthly income ＞ 5 000 yuan （OR＝1.742）， awareness of pharmaceutical care or pharmacists （OR＝3.620）， and the desire to receive pharmaceutical care （OR＝4.686） （P＜0.05）， while self-rating health as “good” （OR＝0.390） was a negative influencing factor （P＜0.05）. Cardiovascular and cerebrovascular diseases （54.48%） and antihypertensive drugs （45.05%） were the service scenarios that the surveyed patients most hope to be covered. 85.14% of the patients preferred “service when xiaochnye@126.com needed”， with a single service duration of less than 10 minutes being appropriate （84.43%）， and the willingness to pay within 20 yuan being the main type （85.38%）. CONCLUSIONS Based on the characteristics of patients’ needs and payment behaviors， it is suggested that our country could consider establishing a hierarchical payment mechanism for pharmaceutical care， and focus on differentiated design in combination with diseases and medication situations. At the same time， the rights， responsibilities and service standards of resident pharmacists in the links such as medication reorganization and medical order review should be further clarified to comprehensively enhance the clinical value and policy operability of pharmaceutical care.

Primary splenic lymphoma is a rare malignant neoplasm， with similar clinical manifestations to Sjogren’s syndrome and liver cirrhosis， which often leads to misdiagnosis. This article reports a case of primary splenic lymphoma misdiagnosed as Sjogren’s syndrome with liver cirrhosis， in order to improve the understanding of primary splenic lymphoma， Sjogren’s syndrome， and liver cirrhosis and avoid misdiagnosis and treatment delay.

Objective To observe the effects of Bushen Antai Mixture on angiogenesis at the maternal fetal interface in recurrent spontaneous abortion(RSA)mice;To explore its mechanism in treating RSA based on the VEGF/Hippo/YAP pathway.Methods RSA mouse model and normal pregnancy mouse were constructed using Clark classic method.RSA model mice were randomly divided into model group,progesterone group,Bushen Antai Mixture low-,medium-and high-dosage groups,and normal pregnant mice were used as normal group,with 10 mice in each group.Starting from the first day of pregnancy,each medication group was given the corresponding medication by gavage for 15 days.The absorption rate of mouse embryos was calculated,the morphology of decidual tissue were observed by HE staining,the mRNA and protein expression of VEGF and Hippo/YAP pathway-related molecules of decidual tissue were detected by RT-qPCR and Western blot.Results Compared with the normal group,the absorption rate of embryos in the model group significantly increased(P<0.01),the arrangement of decidual tissue cells were disordered,edematous and degenerated,some nuclei disappeared,the vascular density decreased,the mRNA expressions of VEGF,Yes associated protein(YAP),large tumor suppressor factor(LATS)1 and LATS2 in decidual tissue significantly decreased(P<0.01),the protein expression of VEGF decreased(P<0.01),and the protein expressions of p-YAP/YAP and p-LATS/LATS significantly increased(P<0.01).Compared with the model group,the absorption rate of embryos in each dosage group of Bushen Antai Mixture was significantly reduced(P<0.05,P<0.01),the cells in the decidual tissue were arranged in an orderly manner,and edema degeneration was reduced,the mRNA expressions of VEGF,YAP,LATS1 and LATS2 in decidual tissue significantly increased(P<0.05,P<0.01),and the protein expression of VEGF significantly increased(P<0.05,P<0.01),the protein expressions of p-YAP/YAP and p-LATS/LATS decreased(P<0.05,P<0.01).Conclusion Bushen Antai Mixture can promote the expressions of VEGF,YAP,LATS by activating VEGF/Hippo/YAP signaling pathway,promote angiogenesis at the maternal-fetal interface,reduce the pregnancy loss rate,and play a therapeutic effect of RSA.

Objective In order to investigate the patients'medical experiences,willingness to use online diagnosis and treatment in the context of"Internet+medical health",and the factors influencing these choice of medical channels.Methods We conducted an online and offline sampling survey through a questionnaire.1 215 questionnaires were distributed,and 1 010 were valid.After looking at the basic details of the survey participants,we used a logistic regression model to find out what affects patients'willingness to see a doctor online.Results Whether patients have solved their own problem,and the degree of help on the Internet play a significant role in the willingness to recommend Internet diagnosis and treatment.In addition,with the de-crease of age,the improvement of education level,the increase of economic development level of the city where the respondents live,and the decrease of medical expenditure in the past year,residents'willingness to use Internet diagnosis and treatment will show a gradually increasing trend.Conclusion Internet diagnosis and treatment in the future still need to further meet the needs of multi-group medical services,improve and perfect service quality and medical insurance management,to achieve"full node"coverage,"full chain"supervision.

Objective To explore the correlation between central venous oxygen saturation(ScvO2),blood lactate(Lac),arterial oxygen saturation(SaO2)and mechanical ventilation time in infants with congenital heart disease(CHD).Methods Eighty-four CHD children treated in the First People's Hospital of Zunyi were enrolled between January 2020 and December 2024.According to postoperative mechanical ventilation time,they were divided into prolongation group(28 cases,mechanical ventilation time≥72 h)and non-prolongation group(56 cases,mechanical ventilation time<72 h).The clinical data,score of risk adjustment for congenital heart surgery(RACHS-1),levels of ScvO2,and Lac and SaO2 in the two groups were compared.The risk factors of postoperative mechanical ventilation time were analyzed by multivariate logistic regression analysis,and predictive value of ScvO2,Lac and SaO2 for prolonged mechanical ventilation time was analyzed by ROC curves.The clinical outcomes in the two groups were recorded.Results There were significant differences in age,preoperative pneumonia,RACHS-1 grading,and levels of ScvO2,Lac and SaO2 among children with different mechanical ventilation time(P<0.05).Multivariate logistic regression analysis showed that ScvO2,Lac and SaO2 were independent influencing factors of postoperative mechanical ventilation time(P<0.05).ROC curves analysis showed that area under the curve(AUC)values of ScvO2,Lac,SaO2 and combined detection for predicting prolonged postoperative mechanical ventilation were 0.846,0.863,0.839 and 0.917,and the best cut-off values were 67.64％,1.51mmol/L and 96.06％,respec-tively(P<0.05).The failure rate of weaning in the prolongation group was higher,and stay time in PICU and actual length of hospital stay were longer than those in non-prolongation group(P<0.05).Conclusion The levels of ScvO2,Lac and SaO2 are related to mechanical ventilation time in CHD infants.They are all independent risk factors affecting prolonged mechanical ventilation and can be applied as auxiliary detection indexes to predict the prolonga-tion of mechanical ventilation in clinical practice.

Objective To investigate alterations in plasma complement levels and white matter imaging characteristics,along with their relationship in patients with first-episode schizophrenia(SCZ).Methods Thirty-eight patients with first-episode schizophrenia and 42 healthy controls were enrolled.Whole-brain diffusion tensor imaging(DTI)was performed using a Philips 3.0 T MRI scanner.Tract-based spatial statistics(TBSS)combined with the Johns Hopkins University(JHU)white matter labels atlas was used to extract and compare white matter characteristics between the two groups.Plasma levels of complement components(C1q,C3,C4,factor B,factor H,and factor P)were measured using the MILLIPLEX? human complement assay kit via multiplex analysis.Spearman correlation analysis was conducted to examine the association between plasma complement levels and white matter features.Results The radial diffusivity(RD)of the left fornix/stria terminalis was significantly higher in the patient group compared to the control group[(0.62±0.04)×10-3mm2/s vs.(0.60±0.03)×10-3mm2/s,PFDR=0.048)].Factor H[677.71(551.58,846.21)ng/mL vs.582.76(513.93,729.71)ng/mL,P=0.041]and factor P[71.36(57.30,95.99)ng/mL vs.60.08(46.67,80.03)ng/mL,P=0.011]were both significantly elevated compared to the control group.Moreover,RD values in the left fornix/stria terminalis were negatively correlated with plasma C3 levels in the patient group(r=-0.362,P=0.025).Conclusion Patients with first-episode schizophrenia exhibit white matter microstructural abnormalities in left fornix/stria terminalis,which are significantly associated with plasma complement levels.

Objective:To analyze the effects of shared decision-making in patients with type 2 diabetic mellitus.Methods:Databases including PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Datebase, COVIP and SinoMed, for randomized controlled trials (RCTs) on the application of shared decision-making in patients with type 2 diabetic mellitus from inception to July 22, 2023, used R Studio software for meta-analysis.Results:A total of 14 RCTs and 2 606 patients with type 2 diabetic mellitus were included. The results of meta-analysis showed that the shared decision-making can alleviate the decision-making conflict of type 2 diabetic mellitus patients ( MD=-3.18, 95% CI -5.36 to -0.99, P<0.05), improve the decision-making self-efficacy ( MD=5.82, 95% CI 2.34 to 9.30, P<0.05), medication compliance ( RR=1.08, 95% CI 1.01 to 1.16, P<0.05), and diabetes-related knowledge ( SMD=0.46, 95% CI 0.16 to 0.75, P<0.05), reduce BMI ( MD=-0.75, 95% CI-1.33 to -0.17, P<0.05) and the HbA1c level ( MD=-0.45, 95% CI -0.65 to -0.24, P<0.05) in the 3-month follow-up. Conclusions:The shared decision-making improves the self-management in patients with type 2 diabetic mellitus. However, the long-term effect and potential risks of this model still need to be further studied. It is suggested that the application of shared decision-making in type 2 diabetic mellitus patients should be optimized in the future, and research on the long-term effects and potential risks of this model should be increased.

Objective To explore the clinical efficacy of erigeron breviscapus injection combined with atorvastatin calcium in patients with acute ischemic stroke(AIS)and its impact on systemic inflammatory markers.Methods A total of 151 AIS patients diagnosed and treated from January 2020 to December 2022 were selected and divided into the control group(n=75)and the study group(n=76)by random number method.The control group was given oral atorvastatin calcium treatment,and the study group was additionally treated with erigeron breviscapus injection on this basis.Before treatment,7 d and 14 d after treatment,neurological function[National Institutes of Health Stroke Scale(NIHSS)],motor function[Fugl-Meyer Assessment(FMA)],activities of daily living[Barthel Index(ADL)]and systemic inflammatory markers such as tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin(IL)-6,lymphocytes(LYM),white blood cells(WBC),neutrophils(NEU)and platelets(PLT)were evaluated.Efficacy evaluation was conducted after 14 days of treatment.The adverse reactions of patients during the treatment period were recorded for safety assessment.Results The NIHSS score,TNF-α,CRP,IL-6,WBC,NEU and PLT levels were lower in the study group than those in the control group after 7 d and 14 d treatment,and decreased with the increase of treatment time(P＜0.05).After 7 d and 14 d treatment,FMA score,ADL score and LYM level were higher in the study group than those in the control group,and increased with the prolongation of treatment time(P＜0.05).TNF-α,CRP,IL-6,WBC,NEU and PLT were positively correlated with NIHSS score,and negatively correlated with FMA score and ADL score.LYM was negatively correlated with NIHSS score,and positively correlated with FMA score and ADL score(P＜0.05).The total effective rate was higher in the study group than that of the control group(P＜0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P＞0.05).Conclusion After the combined treatment of AIS with erigeron breviscapus injection and atorvastatin calcium,the systemic inflammatory level of patients decreases significantly,the curative effect is good and the safety is high.

The number of maintenance hemodialysis patients in China has been steadily increasing. With the continuous iteration of technological innovations, healthcare has entered a new phase of digital healthcare development. This paper summarizes the overview and development of digital healthcare and its application in patients with maintenance hemodialysis. It also discusses existing challenges and corresponding strategies, aiming to provide references for the development of digital healthcare in hemodialysis.

Objective To explore the interplay between MCT1-mediated lactate accumulation and ferroptosis in acute liver failure(ALF).Methods An ALF mouse model and a hepatocyte injury model were established using lipopolysaccharide(LPS)in combination with D-galactosamine(D-GalN).The mice were randomly assigned to three groups:a blank control group,an ALF model group,and an ALF+Liproxstatin-1(Lip-1)treatment group.In vitro experiments included four groups:A blank control,a hepatocyte injury model,a lactate intervention,and an MCT1 overexpression group.Commercial kits were used to measure lactate levels in both mouse liver tissues and cell supernatants,as well as the contents of malondialdehyde(MDA),ferrous ions(Fe2+),and reduced glutathi-one(GSH)in liver tissue.Liver histopathology was evaluated using hematoxylin and eosin(HE)staining.Trans-mission electron microscopy was employed to assess mitochondrial ultrastructure in hepatocytes.Western blot(WB)analysis was performed to determine the protein expression levels of MCT1,glutathione peroxidase 4(GPX4),and acyl-CoA synthetase long-chain family member 4(ACSL4)in both liver tissues and cultured cells.Real-time quantitative PCR and immunofluorescence assays were utilized to detect mRNA expression and fluorescence intensity of GPX4 and ACSL4,respectively.Results HE staining of liver tissue from the ALF mouse model revealed extensive hepatocyte necrosis and partial inflammatory cell infiltration.Both MCT1 and GPX4 protein expression were significantly downregulated(P<0.001),whereas ACSL4 protein expression was markedly upregulated(P<0.000 1),accompanied by a significant elevation in lactate levels(P<0.001).Trans-mission electron microscopy demonstrated reduced mitochondrial volume and disorganized cristae arrangement in hepatocytes.In contrast to the model group,histological analysis of liver tissue from ALF mice treated with an iron death inhibitor showed attenuated liver injury.GPX4 expression was restored(P<0.05),while ACSL4 expression was reduced(P<0.001).Levels of lactate,MDA,and Fe2+in liver tissue were significantly lower(P<0.001),whereas GSH levels were significantly higher(P<0.05).In vitro experiments indicated that lactate treatment suppressed GPX4 expression in hepatocytes in a concentration-dependent manner while promoting ACSL4 expres-sion(P<0.05).In the hepatocyte injury model group,MCT1 and GPX4 expression were downregulated,ACSL4 protein expression was upregulated(P<0.05),and lactate levels were significantly increased(P<0.05).However,MCT1 overexpression effectively reversed these alterations,resulting in increased GPX4 expression(P<0.05)and decreased ACSL4 expression(P<0.001).Furthermore,immunofluorescence results revealed enhanced GPX4 fluorescence intensity(P<0.001)and reduced ACSL4 signal intensity(P<0.01),along with a marked reduction in lactate levels in cell supernatants(P<0.000 1).Conclusions This study demonstrates that ferroptosis plays a critical role in cell death during ALF and is closely intertwined with lactate metabolism.MCT1 mitigates LPS/D-GalN-induced ferroptosis by facilitating lactate transport in hepatocytes,thereby reducing lactate accumulation.Conversely,inhibition of ferroptosis leads to decreased lactate levels,indicating a bidirectional'lactate-ferroptosis'regulatory loop.