Objective:To construct a medical quality evaluation index system for inpatients in public hospitals based on the life cycle theory,starting from the entire process of medical treatment.Method:A comprehensive study was conducted on the screening of medical quality evaluation indicators for hospitalized patients using literature analysis,key informant interviews,and expert inquiry methods.Results:The effective recovery rate of the two rounds of expert consultation was 100%,with high enthusiasm from the experts.The authority coefficient was above 0.7,and Kendall's W coordination coefficient was 0.267(P＜0.05).The evaluation indicators for medical quality of hospitalized patients,including 3 primary indicators,10 secondary indicators,and 51 tertiary indicators,were determined.Conclusions:The medical quality evaluation index system for inpatients in public hospitals based on the life cycle theory has certain scientificity and reliability.However,the weight analysis of the index system has not been carried out and is still in the theoretical exploration stage.Further empirical research is needed for verification and improvement.

Up to 90%of cancer-related deaths worldwide are associated with tumor metastasis.In particular,bone metastases substantially reduces patient survival and quality of life.Abnormal osteoclast activation plays a crucial role in bone metastasis by promoting bone matrix degradation that exacerbates tumor growth and spread.Although osteoclast-targeting drugs,such as bisphosphonates,are widely used in clinical practice,adverse reactions limit their use.Further exploration of the mechanism of action of osteoclasts,as well as non-traditional drug treatments are required to prevent bone metastasis.This article reviews recent domestic and international research into multidisciplin-ary treatment strategies,including comprehensive chemotherapy,immunotherapy,and targeted therapy.The review aims to stimulate op-timization of clinical diagnosis and treatment strategies,development of novel treatment plans,and to provide a new theoretical basis and practical guidance for extending patient survival and improving quality of life.

Objective:To evaluate the efficacy and safety of rituximab (RTX) in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN).Methods:This was a single-center, retrospective and single-arm study. The clinical data of AAGN patients who received RTX induction therapy at the First Affiliated Hospital of Zhejiang University School of Medicine from April 2016 to July 2021 and had a follow-up period of more than 6 months were collected. The follow-up was up to June 2022. The Birmingham Vasculitis Activity Score (BVAS) from 2003 was used to assess vasculitis activity. The treatment regimen for RTX was once every 1 to 2 weeks, with 375 mg/m 2 each time. For some patients, the dose was adjusted according to the immune status before medication. The clinical outcomes, renal remission, recurrence and safety was analyzed. Kaplan-Meier method was used to analyze the cumulative renal remission rate. Results:A total of 43 AAGN patients were included in the study, with age of (57.6±16.6) years, 19 males (44.2%) and 34 (79.1%) newly treated patients. There were 34 patients (79.1%) with positive myeloperoxidase-ANCA and 8 patients (18.6%) with positive proteinase 3-ANCA. The dosage of RTX used at the 12-month follow-up was 600 (500, 1 200) mg. At 6 months of follow-up, 32 patients (74.4%) achieved renal remission, and renal remission time was 5.0 (3.3, 5.8) months. Three patients (7.0%) progressed to end-stage renal disease, and two patients (4.7%) died. Compared with patients without renal remission, patients with renal remission had lower baseline serum creatinine ( Z=-2.853, P=0.004), serum uric acid ( t=-2.861, P=0.007), urine protein/urine creatinine ratio ( Z=-2.130, P=0.033) and proportion of methylprednisolone pulse therapy ( χ 2=5.002, P=0.025), and higher estimated glomerular filtration rate ( Z=-2.728, P=0.006). At 12 months of follow-up, 33 patients (76.7%) achieved renal remission, and the cumulative renal remission rate was 82.4%. Two patients (4.7%) had renal recurrence, 5 patients (11.6%) progressed to end-stage renal disease, and 3 patients (7.0%) died. Infection (4 patients, including 2 severe infections) was the main adverse event, all of which occurred within 6 months of RTX treatment. Conclusions:The clinical remission rate and safety of RTX in the treatment of AAGN are both relatively high.

Objective:To construct a medical quality evaluation index system for inpatients in public hospitals based on the life cycle theory,starting from the entire process of medical treatment.Method:A comprehensive study was conducted on the screening of medical quality evaluation indicators for hospitalized patients using literature analysis,key informant interviews,and expert inquiry methods.Results:The effective recovery rate of the two rounds of expert consultation was 100%,with high enthusiasm from the experts.The authority coefficient was above 0.7,and Kendall's W coordination coefficient was 0.267(P＜0.05).The evaluation indicators for medical quality of hospitalized patients,including 3 primary indicators,10 secondary indicators,and 51 tertiary indicators,were determined.Conclusions:The medical quality evaluation index system for inpatients in public hospitals based on the life cycle theory has certain scientificity and reliability.However,the weight analysis of the index system has not been carried out and is still in the theoretical exploration stage.Further empirical research is needed for verification and improvement.

Up to 90%of cancer-related deaths worldwide are associated with tumor metastasis.In particular,bone metastases substantially reduces patient survival and quality of life.Abnormal osteoclast activation plays a crucial role in bone metastasis by promoting bone matrix degradation that exacerbates tumor growth and spread.Although osteoclast-targeting drugs,such as bisphosphonates,are widely used in clinical practice,adverse reactions limit their use.Further exploration of the mechanism of action of osteoclasts,as well as non-traditional drug treatments are required to prevent bone metastasis.This article reviews recent domestic and international research into multidisciplin-ary treatment strategies,including comprehensive chemotherapy,immunotherapy,and targeted therapy.The review aims to stimulate op-timization of clinical diagnosis and treatment strategies,development of novel treatment plans,and to provide a new theoretical basis and practical guidance for extending patient survival and improving quality of life.

Objective:To evaluate the efficacy and safety of rituximab (RTX) in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN).Methods:This was a single-center, retrospective and single-arm study. The clinical data of AAGN patients who received RTX induction therapy at the First Affiliated Hospital of Zhejiang University School of Medicine from April 2016 to July 2021 and had a follow-up period of more than 6 months were collected. The follow-up was up to June 2022. The Birmingham Vasculitis Activity Score (BVAS) from 2003 was used to assess vasculitis activity. The treatment regimen for RTX was once every 1 to 2 weeks, with 375 mg/m 2 each time. For some patients, the dose was adjusted according to the immune status before medication. The clinical outcomes, renal remission, recurrence and safety was analyzed. Kaplan-Meier method was used to analyze the cumulative renal remission rate. Results:A total of 43 AAGN patients were included in the study, with age of (57.6±16.6) years, 19 males (44.2%) and 34 (79.1%) newly treated patients. There were 34 patients (79.1%) with positive myeloperoxidase-ANCA and 8 patients (18.6%) with positive proteinase 3-ANCA. The dosage of RTX used at the 12-month follow-up was 600 (500, 1 200) mg. At 6 months of follow-up, 32 patients (74.4%) achieved renal remission, and renal remission time was 5.0 (3.3, 5.8) months. Three patients (7.0%) progressed to end-stage renal disease, and two patients (4.7%) died. Compared with patients without renal remission, patients with renal remission had lower baseline serum creatinine ( Z=-2.853, P=0.004), serum uric acid ( t=-2.861, P=0.007), urine protein/urine creatinine ratio ( Z=-2.130, P=0.033) and proportion of methylprednisolone pulse therapy ( χ 2=5.002, P=0.025), and higher estimated glomerular filtration rate ( Z=-2.728, P=0.006). At 12 months of follow-up, 33 patients (76.7%) achieved renal remission, and the cumulative renal remission rate was 82.4%. Two patients (4.7%) had renal recurrence, 5 patients (11.6%) progressed to end-stage renal disease, and 3 patients (7.0%) died. Infection (4 patients, including 2 severe infections) was the main adverse event, all of which occurred within 6 months of RTX treatment. Conclusions:The clinical remission rate and safety of RTX in the treatment of AAGN are both relatively high.

Pain not only affects the physical and mental health of individuals, but also imposes a huge burden on society as a whole. Traditional pain management measures are diverse, but each has its limitations. Therefore, there is an urgent need for new tools. Digital therapies are booming, and virtual reality (VR) has been widely used, especially in the field of pain management. VR uses assistive tools, such as headsets, to build a three-dimensional virtual world with the participation of multiple senses, including vision, hearing, and smell, so that it can make user feel being there. This review aims to summarize the application and mechanism of VR in the field of pain management, with the hope of making VR a new choice for pain management.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Infant, Newborn ; Humans ; Infant, Premature ; Infant, Low Birth Weight ; Blood Transfusion ; Infant, Premature, Diseases

Objective:To explore the laboratory characteristics and diagnostic methods for therapy-related acute megakaryocytic leukemia (t-AMKL).Methods:The data of one child with acute lymphoblastic leukemia (ALL) in the Blood Disease Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College in September 2014 was retrospectively analyzed. After inducing remission for more than 43 months, the child was diagnosed as t-AMKL.Results:After the diagnosis of ALL, the child was given chemotherapy with standard childhood ALL regimen. After 43 months, t-AMKL was diagnosed by comprehensive morphology, cytogenetics, and molecular biology. Bone marrow morphology showed that the proportion of primitive cells was 0.44; flow cytometry showed the phenotype was abnormal myeloid primitive cells; the pathology result showed that the abnormal cells weakly expressed CD42b and CD61; the electron microscopy showed platelet peroxidase (PPO)-positive and myeloperoxidase (MPO)-negative; the bone marrow immunohistochemistry showed the positive rate of CD41 was 34%; the child had a complex karyotype. After reviewing his medical history, he was diagnosed as t-AMKL.Conclusion:The t-AMKL is relatively rare, and it is helpful to improve the prognosis of patients by completing the relevant examinations for early diagnosis.