Objective To evaluate the medical service performance of a hospital in 2023,providing references for the refined management and discipline advancement.Methods The DRG-related data of patients discharged from the sample hospi-tal in 2023 were obtained through the DRGs in Sichuan Province.A comprehensive evaluation was performed by using the inte-grated approach of TOPSIS and RSR with entropy weight.Results The top three specialties offering a wide range of medical services and handling more complex cases on average were neurosurgery,orthopedics,and cardiovascular medicine.The difficulty level of cases in these departments exceeded the average for both the city and the province.TOPSIS-RSR method was used to e-valuate six weights of the index,and the top three ones were CMI,total weight,and number of diagnostic-related groups.In the DRG performance evaluation,30 clinical departments were divided into 3 grades,with 5,21,and 4 departments in each grade,respectively,revealing differences in case structure across grades.Conclusion The combination of DRG-related indicators and comprehensive evaluation method can be effectively applied to the performance evaluation of medical service for inpatients,thus providing suggestions and strategies for promoting the improvement of medical service capacity,improving medical service effi-ciency,optimizing safety and quality assessment indicators,and achieving overall balanced development in wards.

AIM: To identify the primary active components and underlying mechanisms of Yijing Decoction(YJD)in treating early diabetic retinopathy(DR)based on liquid chromatography-mass spectrometry and network pharmacology.METHODS: Active components of YJD were characterized through LC-MS. Components with optimal ADME(absorption, distribution, metabolism, excretion)properties were selected as key bioactive candidates. Network pharmacology approaches were employed to predict YJD-DR therapeutic targets. Protein-protein interaction(PPI)networks, gene ontology(GO)enrichment analysis, and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis were subsequently conducted to predict core targets and networks. Critical targets and pathways were experimentally validated through Western blot.RESULTS: Ten core therapeutic targets were identified, including TNF, Alb, EGFR, STAT3, PTGS2, ESR1, PPAR, MMP9, TLR4, and MAPK. YJD was related to cancer-related signaling, fluid shear stress and atherosclerosis, and neurodegenerative diseases, encompassing key biological processes such as inflammatory response regulation, programmed cell death activation, and enhanced cell migration. Furthermore, Western blot analysis confirmed that YJD significantly inhibited high glucose-induced phosphorylation of STAT3(P-STAT3/STAT3)and ERK(P-ERK/ERK)in rat retinal microvascular endothelial cells.CONCLUSION: This study revealed YJD's pharmacodynamical basis and its multi-component, multi-target, and multi-paths pharmacology. YJD exerts therapeutic effects on DR by coordinately regulating critical signaling pathways and alleviating intraocular inflammation, thus preserving retinal vascular endothelial cells, maintaining blood-retinal barrier integrity, and facilitating retinal neurovascular repair.

Objective To evaluate the medical service performance of a hospital in 2023,providing references for the refined management and discipline advancement.Methods The DRG-related data of patients discharged from the sample hospi-tal in 2023 were obtained through the DRGs in Sichuan Province.A comprehensive evaluation was performed by using the inte-grated approach of TOPSIS and RSR with entropy weight.Results The top three specialties offering a wide range of medical services and handling more complex cases on average were neurosurgery,orthopedics,and cardiovascular medicine.The difficulty level of cases in these departments exceeded the average for both the city and the province.TOPSIS-RSR method was used to e-valuate six weights of the index,and the top three ones were CMI,total weight,and number of diagnostic-related groups.In the DRG performance evaluation,30 clinical departments were divided into 3 grades,with 5,21,and 4 departments in each grade,respectively,revealing differences in case structure across grades.Conclusion The combination of DRG-related indicators and comprehensive evaluation method can be effectively applied to the performance evaluation of medical service for inpatients,thus providing suggestions and strategies for promoting the improvement of medical service capacity,improving medical service effi-ciency,optimizing safety and quality assessment indicators,and achieving overall balanced development in wards.

OBJECTIVE To systematically investigate the current status and effectiveness of the standardized on-the-job training program for community clinical pharmacists in Shanghai,and to provide a scientific basis for optimizing the training scheme.METHODS A questionnaire survey was conducted to collect the data from trainees and mentor pharmacists who participated in the program between 2016 and 2024.The survey examined their basic information,evaluations of the training scheme,satisfaction with training outcomes,and suggestions for improvement.Statistical analyses were also conducted.RESULTS A total of 420 valid responses were collected,including 340 from trainees and 80 from mentor pharmacists.Before training,only 30.29%of trainees were engaged in clinical pharmacy-related work,whereas this proportion increased to 73.24%after training.Most mentor pharmacists had extensive experience in clinical pharmacy(76.25%with≥5 years of experience)and mentoring(78.75%with≥3 teaching sessions).Totally 65.59%of trainees and 55.00%of mentor pharmacists believed that blended training yielded the best learning outcomes.Over 80.00%of both trainees and mentor pharmacists considered the overall training duration,theoretical study time,and practical training time to be reasonable.More than 95.00%of trainees and mentor pharmacists agreed that the homework and assessment schemes were appropriate.Trainees rated the relevance of training content to their actual work highly(with an average relevance score＞4.5),though they perceived the chronic disease medication therapy management module as significantly more challenging than the prescription review and evaluation module and the home-based pharmaceutical care module.The average satisfaction score of trainees and mentor pharmacists with the training effectiveness of each project was above 4 points,indicating a high overall satisfaction.Inadequate provision of teaching resources was unanimously recognized by trainees and mentor pharmacists as the key area requiring improvement.CONCLUSIONS The standardized on-the-job training program for community clinical pharmacists in Shanghai has contributed to improving pharmaceutical services in community healthcare settings.However,ongoing improvements must concentrate on content design,resource development,and faculty cultivation.

Damage to organelles plays a significant role in myocardial ischemia/reperfusion injury,which results in the dysfunction of mitochondria and other related organelles.The communication between mitochondria and other organ-elles can also affect the development of myocardial ischemia/reperfusion injury.For instance,the mitochondria-associated endoplasmic reticulum membrane provides a"seamless connection"and regulates the exchange of organelles and metabolites(such as ions,lipids and proteins)between the mitochondria and the endoplasmic reticulum,which subse-quently affects myocardial ischemia/reperfusion injury.However,there is a lack of studies regarding the interaction be-tween mitochondria and related organelles,which is a critical component in triggering myocardial ischemia/reperfusion inju-ry.Therefore,this article describes the role of mitochondrial crosstalk with endoplasmic reticulum,lysosomes and nuclei in myocardial ischemia/reperfusion injury,and aims to provide a theoretical basis for targeting mitochondrial crosstalk with other organelles in the treatment of myocardial ischemia/reperfusion injury.

Purpose To predict the 2015 American thyroid association(ATA)recurrence risk stratification based on ultrasonographic features and Hashimoto's thyroiditis(HT)-specific antibody status of papillary thyroid carcinoma(PTC)in the context of HT.Materials and Methods A retrospective analysis was conducted on the ultrasonographic and clinical data of 479 patients with coexisting PTC and HT,who underwent their first thyroid surgery at the First Medical Center of Chinese PLA General Hospital from January 2017 to December 2019.All patients were divided in chronological order into a training group(n=327)and a validation group(n=152).Multivariate Logistic regression analysis was utilized to identify independent factors associated with high recurrence risk stratification according to the ATA guidelines.Predictive models were constructed and screened,and the efficacy of these models was evaluated using the area under the curve,calibration curves and Brier scores.Results Multivariate Logistic regression analysis identified the following as independent predictive factors for high recurrence risk stratification:multifocal malignancy of nodules(OR=3.812,95％CI 1.275-11.397,P=0.017),nodule contact with the capsule(OR=8.012,95％CI 1.647-38.972,P=0.010),microcalcifications(OR=4.220,95％CI 1.302-13.678,P=0.016),an aspect ratio＞1(OR=4.017,95％CI 1.286-12.548,P=0.017),abundant nodule vascularity(OR=6.120,95％CI 2.225-16.832,P＜0.001),maximum nodule diameter ≥1 cm(OR=4.784,95％CI 1.360-16.833,P=0.015),a glandular echo characteristic of typical HT(OR=0.114,95％CI 0.039-0.330,P＜0.001),and anti-thyroid peroxidase antibody monopositivity(OR=0.088,95％CI 0.006-1.299,P=0.077).The predictive model demonstrated strong performance,as evidenced by the area under the curve of 0.942(95％CI 0.911-0.972)in the training set and 0.933(95％CI 0.878-0.990)in the validation set.Both groups exhibited well-fitting calibration curves.The Brier scores were 0.054 and 0.058 for the training and validation sets,respectively,indicating excellent predictive efficacy of the model.Conclusion The preoperative prediction model,based on ultrasonographic features combined with antibody status,demonstrates good efficacy in assessing ATA recurrence risk stratification for coexisting PTC and HT patients,which can assist clinicians in formulating treatment plans.

Humans ; Aminoquinolines/therapeutic use* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Mutation/genetics* ; Standard of Care

Objective To observe the value of micro flow imaging(MFI)for diagnosing closed liver trauma in pigs.Methods A self-made impactor was used to impact the liver of 15 healthy pigs under general anesthesia and establish pig models of closed liver trauma.Conventional ultrasound,MFI and contrast-enhanced ultrasound(CEUS)were used to observe the location,extent and degree of liver trauma.Afterwards,the pigs were executed and the livers were removed,and the liver lesions were observed.According gross pathological findings,the diagnostic efficacy of MFI was analyzed.Results Gross pathology showed a total of 29 liver traumas in 15 pigs.The accuracy rate of conventional ultrasound,MFI and CEUS for diagnosing liver trauma in pigs was 37.93％(11/29),82.76％(24/29)and 96.55％(28/29),respectively.Significant difference was found between conventional ultrasound and MFI,also between conventional ultrasound and CEUS(both P＜0.05),but not between MFI and CEUS(P＞0.05).MFI showed no obvious blood flow signal in more than half pig liver trauma sites,while showed"spring like"in 1 pig and scattered blood flow signals in 5 pigs.On CEUS,liver trauma sites in pigs present as low or no perfusion,while"jet like"contrast agent overflow from the liver was noticed in 1 pig and"spring like"contrast agent overflow in 5 pigs,forming liquid dark areas around the liver or in abdominal cavity.Conclusion MFI had certain value for diagnosing closed liver trauma in pigs,hence being comparable to CEUS.

Objective:To compare the genotypes and phenotypes between the monozygotic twins via whole genome sequencing to further clarify the autosomal dominant inherited neurofibromatosis type 1 (NF1) variants related to congenital pseudarthrosis (CP).Methods:According to the diagnostic criteria of congenital tibial pseudarthrosis and the clinical diagnostic criteria of NF1, two pairs of monozygotic twins with NF1 were included. Both were female and only one of each pair had congenital pseudarthrosis. The other did not have congenital pseudarthrosis. Whole genome sequencing was performed using the peripheral blood of the two pairs of monozygotic twins. Customized bioinformatics analysis was then performed to identify single nucleotide variants (SNVs), short insertion deletion variants (InDel), copy number variants (CNVs), and structural variants (SVs). Classified the variants according to the American College of Medical Genetics and Genomics (ACMG) and ClinGen criteria. The germline variants within the monozygotic twins were compared to identify the CP patients' unique variants. The shared pathogenic or likely pathogenic germline variants between the unique variants in the CP patients from the twins were also analyzed. Further, the identified disease-causing variants were validated by Sanger sequencing in the family of the twins and their parents. Finally, the genotypes and phenotypes regarding the pathogenic variants of the NF1 gene among the twins were characterized. Results:Both the two monozygotic twins were identified pathogenic variants in the NF1 gene. One with c.3047_3048del (p.Cys1016SerfsTer4), and the other with c.4267A>G (p.Lys1423Glu). By Sanger sequencing validation in family quads, the two CP patients and their siblings harbored de novo heterozygous variants of the NF1 gene. In addition to the NF1 gene, no other genes were identified pathogenic or likely pathogenic variants uniquely in the CP patients compared with their twin sisters, as well as SVs and CNVs. In addition, by analyzing the rare and damaging variants in the two CP patients from the two twins, they had no overlapping genes against the SNVs, InDels, SVs, or CNVs. Conclusion:Whole genome sequencing revealed that both the two monozygotic twins with NF1 were detected pathogenic variants of gene NF1. No other pathogenic variants specific to the CP patients among the twins were identified. The two CP patients shared no other common genes from the detected likely pathogenic variants.

Objective:To explore the relationship between the binaural high-frequency mean hearing threshold and the hypertension of female workers exposed to noise, and to understand the application significance of the binaural high-frequency mean hearing threshold as an internal effect indicator of the risk of hypertension in female workers exposed to noise.Methods:From January to December 2018, a total of 20882 female workers exposed to noise in Guangzhou were selected by cluster sampling. Pure tone audiometry, blood pressure, age and length of service were collected. Trend test was used to evaluate the effects of exposure to noise and binaural high-frequency mean hearing threshold on blood pressure. Binary logistic regression model was used to evaluate the risk of hypertension associated with exposure to noise and binaural high-frequency mean hearing threshold.Results:The detection rate of normal hearing threshold, mild hearing loss and severe hearing loss was 80.73% (16858/20882) , 16.21% (3384/20882) and 3.06% (640/20882) respectively. The prevalence of hypertension was 6.04% (1018/16858) in normal hearing group, 10.28% (348/3384) in patients with high frequency mild hearing loss, and 11.25% (72/640) in patients with high frequency severe hearing loss. There was a linear relationship between the increase of working age and high-frequency mean hearing threshold and the increase of systolic and diastolic blood pressure ( P< 0.05) . Compared with those exposed to noise for less than 1 year, the risk of hypertension in female workers with 7-9 years and more than 9 years was decreased ( OR= 0.79, 0.75, P<0.05) . Compared with normal hearing group, the risk of hypertension in high frequency mild hearing loss group was increased ( OR=1.31, P<0.05) . Conclusion:The increase in the binaural high-frequency mean hearing threshold of female workers exposed to noise can increase the blood pressure level and the risk of hypertension, and attention should be paid to female workers with high-frequency mild hearing loss.