OBJECTIVE To summarize the implementation experiences of the China Hospital Association’s Clinical Pharmacist Instructor Training Program Reform， and to evaluate the effectiveness of the reform， thus continuously enhancing the quality and standards of clinical pharmacist instructor training. METHODS The study drew on project evaluation methodologies to summarize the main characteristics of the comprehensive system and new model for clinical pharmacist instructor training established through the reform by literature review. The “learning assessment” and “reaction assessment” were conducted by using Kirkpatrick’s four-level model of evaluation in order to evaluate the effectiveness of the clinical pharmacist instructor training reform through statistically processing and analyzing the performance data and teaching evaluation data of the instructor participants. Based on problem and trend analysis， the future development directions were anticipated for the reform of clinical pharmacist instructor training. RESULTS & CONCLUSIONS The latest round of clinical pharmacist instructor training reform initiated by the Chinese Hospital Association had initially established a four-pronged training system encompassing “recruitment， training， assessment， and management”. It had also forged a training 。 model “oriented towards enhancing clinical teaching competency， with practical learning and skill-based assessment conducted on clinical teaching sites as its core”. Following a period of over three years of gradual reform， the new training system and model became increasingly mature. In both 2023 and 2024， the participants achieved relatively high average total scores in their initial completion assessments [with scores of （84.05± 5.83） and （85.82±4.35） points， respectively]. They also reported a strong sense of gain from the training reform [with self- perceived gain scores of （4.80±0.44） and （4.85±0.39） points， respectively]. The operation and implementation effects of the reform were generally satisfactory. In the future， clinical pharmacist instructor training reforms should continue to address the issues remaining from the current phase， while aligning with global trends in pharmacy education and industry development. Additionally， sustained exploration and practice will be carried out around the core objective of “enhancing clinical teaching competence”.

Objective:To explore the application of three-level task-driven teaching based on motivational regulation strategy in training nurse interns in the Department of Clinical Psychology.Methods:This study included 80 nurse interns in the Department of Clinical Psychology at Zhejiang Provincial People's Hospital between June 2021 and May 2024 as research subjects. They were divided into a control group ( n=40) and an experimental group ( n=40). The control group received traditional teaching, while the experimental group received three-level task-driven teaching based on motivational regulation strategy, covering basic knowledge mastery, practical operation improvement, and comprehensive ability enhancement. Through scenario guidance and simulation exercises, the intrinsic motivation of nurse interns was stimulated. The assessment scores, self-learning ability, teaching quality, and recognition of teaching were compared between the two groups of nurse interns. Results:After teaching, the experimental group scored higher than the control group on theoretical assessment [(86.05±5.86) vs. (74.35±4.72)] and operational skill assessment [(88.18±5.67) vs. (82.65±6.09)] ( P<0.001). The total score and scores of various dimensions of teaching quality were higher in the experimental group compared to those in the control group ( P<0.001). After teaching, the total score and scores of various dimensions of self-learning ability of both groups were higher than those before teaching, and the scores were higher in the experimental group than in the control group ( P<0.05). Conclusions:The three-level task-driven teaching based on motivational regulation strategy can significantly improve the assessment scores, self-learning abilities, and teaching quality of nurse interns in the Department of Clinical Psychology. Additionally, this method can enhance their recognition of nursing internship teaching. This teaching method is worth promoting.

Objective To investigate the impact of pharmaceutical services provided by clinical pharmacists on rational drug use and cost control in hepatobiliary surgery under the Diagnosis Related Groups(DRGs)payment model,aming to provide evidence for improving the rationality of drug therapy and saving medical costs.Methods Patients classified under DRGs disease codes HB15,HB13,and HB11 from November 2022 to April 2024 were selected as study subjects.A total of 195 patients were included,with 106 in the intervention group and 89 in the control group.The intervention group received multidimensional clinical pharmaceutical services in addition to the standard care provided to the control group.The rational drug use rate,medication costs,total hospitalization expenses,and length of hospital stay were observed between the two groups.A cost-benefit analysis was employed to evaluate the economic impact of providing pharmaceutical services to hepatobiliary surgical patients.The cost indicator was the clinical pharmacy services cost,and the benefit indicators were the reductions in total hospitalization expenses and medication costs.The benefit-cost ratio(B/C)was calculated,and sensitivity analysis was performed.Results The intervention group showed significantly higher rational use rates of prophylactic antimicrobial agents(drug selection:83.96％vs.46.07％,P＜0.01;treatment duration:84.91％vs.56.18％,P＜0.01)and parenteral nutrition drugs(97.17％vs.73.03％,P＜0.01)compared to the control group.Additionally,the intervention group had significantly reduced the length of hospital stay,total hospitalization expenses,medication costs,and insurance over-expenditure compared to the control group(P＜0.05).Furthermore,clinical pharmacist intervention led to a reduction in medication costs by 4 320.05(2 555.00,5 088.25)yuan(CNY)and total hospitalization expenses by 8 891.12(5 135.05,10 074.03)yuan(CNY).The B/C ratios were 14.24(8.42,16.77)and 29.30(16.92,33.20),respectively,indicating economic efficiency.Sensitivity analysis supported these results.Conclusion Under the DRGs payment model,clinical pharmaceutical services guided by drug therapy pathways contribute to improving rational drug use in hepatobiliary surgery and provide clear economic benefits,playing a positive role in reducing medical costs.

Objective:To investigate the distribution of CGG repeat numbers in the FMR1 gene among reproductive-age women in China, providing data reference for carrier screening and genetic counseling of Fragile X syndrome. Methods:This cross-sectional study recruited 16 610 reproductive-age women from 12 medical institutions between July 2022 and October 2023. Peripheral venous blood samples (3 mL) were collected, and genomic DNA was extracted. The number of CGG repeats in the FMR1 gene was determined using the triplet-primed polymerase chain reaction (TP-PCR) combined with capillary electrophoresis technology. Statistical analyses were performed to assess the prevalence and distribution of CGG repeat expansions. Results:Among 16 610 women of childbearing age, 5 684 (34.220%) women had the same number of CGG repeats in the two alleles of FMR1 gene, and 10 926 (65.780%) women had different numbers of repeats in the two alleles. Among the 33 220 FMR1 alleles in 16 610 women of reproductive age, the most common CGG repeat numbers were 29 [48.645% (16 160/33 220)] and 30 [26.276% (8 729/33 220)], while the most frequent CGG genotype was CGG 29/29 [24.726% (4 107/16 610)]. The CGG repeat numbers of FMR1 gene were normal in 16 498 women (99.326%). Among the 112 women (0.674%) with CGG repeat abnormities, 96 (0.578%) women were classified as intermediate carriers, 15 (0.090%) as premutation carriers, and 1 (0.006%) as a full mutation carrier, whose CGG genotype was (36, >200). Conclusion:In the general reproductive-age female population in China, the normal CGG repeat numbers of the FMR1 gene account for 99.326%, while the intermediate carrier rate is 0.578%, and the combined carrier rate of the premutation and full mutation types is 0.096%.

Objective To investigate the mechanism of action and potential biomarkers of Jiangzhi Qingshen capsules in the treatment of dyslipidaemia based on clinical lipid metabolomics.Methods 30 patients with dyslipidaemia from Zhengzhou Hospital of Chinese Medicine were collected as the test group,and their lipid levels before and after taking Jiang Zhi Qing Shen capsule for 12 weeks were compared.Another 30 healthy patients were enrolled in the physical examination department of Zhengzhou Hospital of Chinese Medicine,and metabolomics investigation was carried out on plasma samples of the test group before and after the treatment as well as those of the healthy patients by LC-MS/MS technology.The differences between the groups were compared by multivariate statistical analysis,and the potential biomarkers were identified by HMDB and lipidblast databases,so as to clarify the possible pathways and targets for the treatment of mild dyslipidaemia by Jiangzhi Qingshen capsules.Results Jiangzhi Qingshen capsules could improve patients' blood lipid level,BMI and abdominal circumference significantly(P<0.05).And metabolomics results showed that 29 lipid metabolites in the plasma of the treated patients were dialled back,which involved cholesterol metabolism,fat digestion and absorption,glycerol-phospholipid metabolism and other biological processes.Conclusion The efficacy of Jiangzhi Qingshen capsules in treating dyslipidaemia was confirmed,and its mechanism of action might be related to the regulation of lipid metabolism.Metabolites such as acylcarnitine(Acar),phosphatidylethanolamine(PE)and phosphatidylcholine(PC)were expected to be used as the biomarkers of dyslipidaemia,so as to provide objective scientific basis for the lipid-lowering capsule,and to facilitate the promotion of its application.

Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome

Colorectal cancer(CRC) is one of the most common malignant tumors worldwide, primarily originating from recurrent inflammatory bowel disease(IBD). Therefore, blocking the inflammation-cancer transformation in the colon has become a focus in the early prevention and treatment of CRC. The inflammation-cancer transformation in the colon involves multiple types of cells and complex pathological processes, including inflammatory responses and tumorigenesis. In this complex pathological process, immune cells(including non-specific and specific immune cells) and non-immune cells(such as tumor cells and fibroblasts) interact with each other, collectively promoting the progression of the disease. In traditional Chinese medicine(TCM), inflammation-cancer transformation in the colon belongs to the categories of dysentery and diarrhea, with the main pathogenesis being cold and heat in complexity. This paper first elaborates on the complex molecular mechanisms involved in the inflammation-cancer transformation process in the colon from the perspectives of inflammation, cancer, and their mutual influences. Subsequently, by comparing the pathogenic characteristics and clinical manifestations between inflammation-cancer transformation and the TCM pathogenesis of cold and heat in complexity, this paper explores the intrinsic connections between the two. Furthermore, based on the correlation between inflammation-cancer transformation in the colon and the TCM pathogenesis, this paper delves into the importance of the interaction between inflammation and cancer. Finally, it summarizes and discusses the clinical and basic research progress in the TCM intervention in the inflammation-cancer transformation process, providing a theoretical basis and treatment strategy for the treatment of CRC with integrated traditional Chinese and Western medicine.
Humans ; Colon/pathology* ; Integrative Medicine ; Animals ; Cold Temperature ; Cell Transformation, Neoplastic/drug effects* ; Medicine, Chinese Traditional ; Hot Temperature ; Inflammation ; Drugs, Chinese Herbal/therapeutic use* ; Colonic Neoplasms/drug therapy*

Artificial intelligence (AI), particularly deep learning, has demonstrated remarkable performance in medical imaging across a variety of modalities, including X-ray, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, positron emission tomography (PET), and pathological imaging. However, most existing state-of-the-art AI techniques are task-specific and focus on a limited range of imaging modalities. Compared to these task-specific models, emerging foundation models represent a significant milestone in AI development. These models can learn generalized representations of medical images and apply them to downstream tasks through zero-shot or few-shot fine-tuning. Foundation models have the potential to address the comprehensive and multifactorial challenges encountered in clinical practice. This article reviews the clinical applications of both task-specific and foundation models, highlighting their differences, complementarities, and clinical relevance. We also examine their future research directions and potential challenges. Unlike the replacement relationship seen between deep learning and traditional machine learning, task-specific and foundation models are complementary, despite inherent differences. While foundation models primarily focus on segmentation and classification, task-specific models are integrated into nearly all medical image analyses. However, with further advancements, foundation models could be applied to other clinical scenarios. In conclusion, all indications suggest that task-specific and foundation models, especially the latter, have the potential to drive breakthroughs in medical imaging, from image processing to clinical workflows.
Humans ; Artificial Intelligence ; Deep Learning ; Diagnostic Imaging/methods* ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Positron-Emission Tomography

Background/Aims: Endoscopic radiofrequency ablation (ERFA) is a treatment option for superficial esophageal squamous cell neoplasia (ESCN), with a relatively low risk of stenosis; however, the long-term outcomes remain unclear. We aimed to compare the long-term outcomes of patients with widespread superficial ESCN who underwent endoscopic submucosal dissection (ESD) or ERFA. Methods: We retrospectively analyzed the clinical data of patients with superficial ESCN who underwent ESD or ERFA between January 2015 and December 2021. The primary outcome measure was recurrence-free survival. Results: Ninety-two and 33 patients with superficial ESCN underwent ESD and ERFA, respectively. The en bloc, R0, and curative resection rates for ESD were 100.0%, 90.2%, and 76.1%, respectively. At 12 months, the complete response rate was comparable between the two groups (94.6% vs 90.9%, p=0.748). During a median follow-up of 66 months, recurrence-free survival was significantly longer in the ESD group than in the ERFA group (p=0.004), while no significant differences in overall survival (p=0.845) and disease-specific survival (p=0.494) were observed.Preoperative diagnosis of intramucosal cancer (adjusted hazard ratio, 5.55; vs high-grade intraepithelial neoplasia) was an independent predictor of recurrence. Significantly fewer patients in the ERFA group experienced stenosis compare to ESD group (15.2% vs 38.0%, p=0.016). Conclusions The risk of recurrence was higher for ERFA than ESD for ESCN but overall survival was not affected. The risk of esophageal stenosis was significantly lower for patients who underwent ERFA.

Background/Aims: Endoscopic radiofrequency ablation (ERFA) is a treatment option for superficial esophageal squamous cell neoplasia (ESCN), with a relatively low risk of stenosis; however, the long-term outcomes remain unclear. We aimed to compare the long-term outcomes of patients with widespread superficial ESCN who underwent endoscopic submucosal dissection (ESD) or ERFA. Methods: We retrospectively analyzed the clinical data of patients with superficial ESCN who underwent ESD or ERFA between January 2015 and December 2021. The primary outcome measure was recurrence-free survival. Results: Ninety-two and 33 patients with superficial ESCN underwent ESD and ERFA, respectively. The en bloc, R0, and curative resection rates for ESD were 100.0%, 90.2%, and 76.1%, respectively. At 12 months, the complete response rate was comparable between the two groups (94.6% vs 90.9%, p=0.748). During a median follow-up of 66 months, recurrence-free survival was significantly longer in the ESD group than in the ERFA group (p=0.004), while no significant differences in overall survival (p=0.845) and disease-specific survival (p=0.494) were observed.Preoperative diagnosis of intramucosal cancer (adjusted hazard ratio, 5.55; vs high-grade intraepithelial neoplasia) was an independent predictor of recurrence. Significantly fewer patients in the ERFA group experienced stenosis compare to ESD group (15.2% vs 38.0%, p=0.016). Conclusions The risk of recurrence was higher for ERFA than ESD for ESCN but overall survival was not affected. The risk of esophageal stenosis was significantly lower for patients who underwent ERFA.