OBJECTIVE To quantitatively evaluate the policies for the commercialization of traditional Chinese medicine preparations in medical institutions into new drugs， and to provide a reference for improving and optimizing China’s policy system for the commercialization of such preparations into new drugs.METHODS Relevant policy documents were retrieved from the PKULaw database and official websites of relevant departments. After collection and screening， the policy texts were text-mined with ROST-CM 6.0 software. A policy modeling consistency （PMC） evaluation index system was constructed by combining the analysis of policy instruments with relevant literature. The PMC indices were calculated through binary assignment， and the evaluation grades were classified. MATLAB R2024a software was used to draw PMC surface maps， so as to reveal the structural characteristics and weak links of the policy system and put forward optimization suggestions. RESULTS &CONCLUSIONS A total of 44 policies related to the commercialization of traditional Chinese medicine preparations in medical institutions into new drugs were included， and a PMC index model containing 10 first-level variables and 44 second-level variables was constructed. The mean PMC index of the 44 policies was 6.07， and the overall evaluation grade was acceptable. Among the first-level variables， “policy nature”“policy approach”“policy evaluation” scored relatively high， whereas “policy instruments”“policy targets” scored relatively low. These findings were mainly reflected in insufficient support measures for funding， professionals and intellectual property rights transformation， limited coverage of policy targets， and relatively inadequate systematic support for commercialization. It is recommended that relevant departments strengthen financial， talent and intellectual property support， enhance local adaptability， expand the coverage of target entities， and formulate special support policies， so as to promote the commercialization of more traditional Chinese medicine preparations with high clinical value and distinctive advantages into new drugs.

Objective:To observe the effectiveness and safety of the application of Wei nasal jet tube(WNJT)in anesthesia induction for patients with extensive facial burns.Methods:A total of 60 patients who underwent multiple systemic scab removal and skin graft-ing surgery in our hospital from July 2021 to July 2023 were enrolled in this study.The patients were 18-60 years of age,with a body mass index of 18-29 kg/m2,ASA II or III,and Mallampati I-III.Using a random number table method,the patients were divided into WNJT ventilation group(W group)and mask ventilation group(M group),with 30 cases in each group.Before anesthesia induction,WNJT was inserted into one side of the nasal cavity for hand controlled normal frequency supraglottic jet ventilation in group W pa-tients,while oxygen ventilation was administered to group M patients through conventional two-hand clasped face masks.After 5 min,tracheal intubation was performed under a visual laryngoscope.The mean amplitude of diaphragm fluctuations,end expiratory carbon dioxide partial pressure(PETCO2),and blood oxygen saturation(SpO2)measured by ultrasound were recorded during spontaneous respi-ration at 5 min of oxygenation and nitrogen removal(T0),as well as at 1 min(T1),2 min(T2),3 min(T3),4 min(T4),and 5 min(T5,im-mediately before intubation)of anesthetic induction.Arterial blood gas(PaO2 and PaCO2)at T0 and T5 were measured.Heart rate(HR)and mean arterial pressure(MAP)were recorded at T0-T5 in both groups of patients.The occurrence of postoperative pharyngeal pain,facial or mandibular angle bleeding,gastrointestinal bloating,and nasal mucosal bleeding were recorded in both groups of pa-tients.Results:At T0,there were no statistically significant differences in mean amplitude of diaphragm fluctuations,HR,MAP,PaO2,PaCO2,PETCO2,and SpO2 between the two groups of patients.At T1-T5,the HR and MAP of patients in the W group were significantly lower than those in the M group(P<0.05).At T5,the PaO2 of patients in the W group was significantly higher than that in the M group,while the PaCO2 and PETCO2 were significantly lower than those in the M group(P<0.05).However,the difference in SpO2 was not sta-tistically significant.The W group had less facial or mandibular angle bleeding and postoperative gastrointestinal bloating than the M group,and the differences were statistically significant(P<0.05).There were no statistically significant differences between the two groups of patients in postoperative pharyngitis and nasal mucosal bleeding(P>0.05).Conclusion:During general anesthesia induction in patients with extensive facial burns,WNJT has the advantages of good ventilation effect,high safety,less complications such as gas-trointestinal bloating and facial or mandibular angle bleeding,and more stable hemodynamics.WNJT has good application prospects in clinical anesthesia.

Objective To investigate the effects of dexmedetomidine injection at the Neiguan acupoint before general anaesthesia on neurocognitive disorder and sleep quality after non-cardiac major surgery in eld-erly people.Methods Elderly patients undergoing elective thoracic and laparoscopic surgery in this hospital from February 2023 to March 2024 were selected and divided into the dexmedetomidine Neiguan acupoint in-jection group(A),saline Neiguan acupoint injection group(B)and dexmedetomidine intravenous injection group(C)by the randomised numerical table method,40 cases in each group.The postoperative neurocognitive function and sleep-related condition in the three groups were observed.Results The incidence rate of postop-erative delirium(POD)on postoperative 1 d in the group A and C was significantly decreased compared with the group B,and the difference was statistically significant(P＜0.05);the incidence rate of POD on postoper-ative 2 d in the group A was significantly decreased compared with the group B(P＜0.05);the incidence rate of postoperative cognitive dysfunction(POCD)on postoperative 1 d in the group A and C was significantly de-creased compared with the group B,moreover which in the group A was lower than that in the group C,and the differences were statistically significant(P＜0.05);the incidence rate of POCD on postoperative 3,5 d in the group A was lower than that in the group B(P＜0.05).The MMSE score on postoperative 1,3,5 d in the group B and C was significantly decreased compared with preoperative 1 d(P＜0.05).The MMSE score on postoperative 1,3,5 d in the group A and C was higher than that in the group B.and the difference was statis-tically significant(P＜0.05).The PSQI score on postoperative 1,3,5 d in the group A and C was increased compared with preoperative 1 d(P＜0.05);compared with the group B,the PSQI score on postoperative 1,3,5 d in the group A and C was decreased,moreover the group A was lower the group C,and the differences were statistically significant(P＜0.05).The incidence rate of bradycardia in the group A and C was signifi-cantly higher than that in the group B(P＜0.05).The incidence rate of postoperative nausea and vomiting(PONV)in the group A was significantly lower than that in the group B and C(P＜0.05),and the difference between the group B and C had no statistical significance(P＞0.05).Conclusion Dexmedetomidine injection at the Neiguan acupoint before anaesthesia for minimally invasive surgery can significantly reduce periopera-tive neurocognitive dysfunction(PND)and improve the quality of sleep in elderly patients,moreover simulta-neously has the effect for preventing PONV.

Objective To observe the sedative and analgesic effect of remazolam combined with sufentanil during ultrasound-guided nerve block in patients undergoing orthopedic surgery.Methods A total of 80 patients who underwent orthopedic surgery in our hospital from January to June 2023 were selected.They were randomly assigned to two groups with 40 cases in each group.In anesthesia preparation room,one group was injected intravenously 10 ml remazolam(0.15 mg/kg)+ sufentanil 0.1 μg/kg(R group)and the other group was injected intravenously 10 ml normal saline +sufentanil 0.1 μg/kg(S group).Ultrasound-guided nerve block was performed 2 min later.The Visual Analogue Scale(VAS)of the two groups were observed during the process of postural position,nerve block puncture and drug injection.Whether there was any discomfort or body movement during the nerve block process were recorded.The mean arterial pressure(MAP),heart rate,and pulse oxygen saturation were measured at baseline,5 min after intravenous injection,nerve block injection,and 10 min after nerve block.Adverse reactions were noted.Results The VAS scores of the R group were 0 point at the time of postural position,nerve block puncture and drug injection,which were significantly lower than those of the S group(all P =0.000).The incidence of sore swelling,electrical sensation,and pain at the time of nerve block of the R group were lower than those of the S group(P<0.05).The incidence of transient glossoptosis of the R group was higher than that of the S group(6 cases vs.0 case,P =0.026).The MAP before and after nerve block in the S group remained at a high level(>95 mm Hg),and the highest MAP appeared at the time point of nerve block;while the MAP of the R group decreased and remained at 80-90 mm Hg after sedation.Conclusion Remazolam combined with sufentanil can provide safe,painless,fear free"comfort medical service"for nerve block sedation and analgesia in anesthesia preparation room,and does not increase the risk of nerve injury and local anesthetic poisoning.

Objective To investigate the effect of L4 transverse process erector spinae plane block(ESPB)before general anesthesia hip surgery in elderly patients on reducing perioperative pain and stress,thus reducing opioid consumption and improving postoperative recovery quality.Methods Sixty patients aged 65 years old and above who underwent unilateral hip surgery from January to December 2023 were randomly divided into two groups(n = 30)by using the random number table method.The ESPB group received ultrasound-guided ESPB at the L4 level with 0.3%ropivacaine(0.5 ml/kg)before induction of anesthesia,while the control group did not receive ESPB.Laryngeal mask anesthesia was administered in both groups.The induction and maintenance methods were consistent in both groups.The Numerical Rating Scale(NRS)was used to evaluate the degree of pain at 8 h and 24 h after surgery.The times of pressing analgesic pump within 24 h after surgery were recorded.The hemodynamic changes at each time point during the operation were observed.The time interval from the end of the operation to the complete recovery and to remove the laryngeal mask were recorded.Intraoperative and Postanesthesia Care Unit(PACU)opioid consumption were noted.The incidence of postoperative agitation,postoperative nausea and vomiting(PONV),dizziness,and the recovery quality score were compared.Results The NRS scores of rest pain and motion pain at 8 h and 24 h after surgery were significantly lower in the ESPB group than those in the control group,and the times of pressing the analgesic pump within 24 h after surgery in the ESPB group was significantly less than that in the control group(P<0.05).The mean arterial pressure(MAP)of the ESPB group at 20 min after peeling was lower than that of the control group[(87.2±15.5)mm Hg vs.(96.7±16.9)mm Hg,P = 0.026].The sufentanil consumption,remifentanil consumption,and the number of cases using urapidil in the ESPB group were significantly lower than those in the control group[12.5(10.0,14.0)μg vs.12.5(12.5,17.5)μg,P =0.041;270(100,400)μg vs.600(448,800)μg,P<0.001;1 case vs.11 cases,P =0.001].The Steward score at30 min after entering PACU was significantly higher in the ESPB group than in the control group[6(5,6)points vs.5(4,5)points,P<0.001].There was no statistical significance in incidence of postoperative agitation,PONV,and dizziness between the two groups(P>0.05).Conclusion Preoperative ESPB at the level of the L4 transverse process can reduce the pain score within 24 h after surgery,reduce the amount of opioid used during and after hip surgery,and improve the quality of postoperative recovery in the elderly.

[摘 要] 目的：探讨肿瘤坏死因子受体相关蛋白1（TRAP1）在结肠癌组织和细胞中的表达及其与临床病理特征和患者预后的关系和相关分子机制。方法：通过TCGA和GEO数据全面分析TRAP1在结肠癌中的表达及其与临床病理特征和患者预后的关系，选取2020年10月至2021年03月间在山西医科大学第一医院手术切除的10例结肠癌组织及相应癌旁组织标本，用IHC染色法检测中国人结肠癌组织中TRAP1的表达进行验证，运行R包（survival和survminer）进行Kaplan-Meier生存分析；在线分析TRAP1蛋白的信号肽及穿膜结构域，通过基因富集分析软件进行GO分析和KEGG分析。培养结肠癌SW480和SW620细胞，将si-NC和si-TRAP1转染结肠癌细胞，实验分为空白对照组、si-NC组和si-TRAP1组，采用qPCR法检测转染后各组结肠癌细胞中TRAP1的表达，FCM检测转染后各组细胞的细胞周期和凋亡情况。结果：与癌旁组织比较，TRAP1在结肠癌组织中呈高表达（P<0.01），TRAP1表达水平与淋巴结转移有关联（P<0.05），TRAP1高表达组结肠癌患者5年OS率较低（P<0.05）。TRAP1蛋白属于细胞质蛋白，功能富集结果显示TRAP1及其相关分子与细胞周期、核糖体生物发生等信号通路有关（均P<0.01），TRAP1高表达组的结肠癌代谢重编程基因簇和线粒体蛋白输入基因簇水平升高（均P<0.01）。敲减TRAP1后，结肠癌细胞周期阻滞于G1期，细胞凋亡水平显著升高（均P<0.01）。结论：TRAP1在结肠癌组织中呈高表达，且与患者淋巴结转移和低OS率相关联，敲减TRAP1可阻滞结肠癌细胞周期并促进其凋亡。

J Objective To investigate the efficacy of butorphanol intravenous analgesia combined with transversus abdominal plane block in postoperative analgesia after cesarean section.Methods A total of 120 cases of cesarean section performed in Jinjiang Hospital from August 2021 to January 2022 were selected for the study.The cases were divided into three groups,according to the different methods of maternal postopera-tive analgesia,the group A was treated with intravenous analgesia(100 mL normal saline containing 3 μg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous analgesia for 48 h);the group B received intravenous analgesia(100 mL normal saline containing 3 pg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous an-algesia for 48 h)combined with transverse abdominal plane block(0.5％ropivacaine given bilaterally on each side).2 μg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous analgesia for 48 h)combined with trans-versus abdominis plane block(10 mL of 0.5％ropivacaine was given bilaterally),and intravenous analgesia in the group C(100 mL of saline containing 2 pg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous anal-gesia for 48 h)combined with transversus abdominis plane block(0.5％ropivacaine 10 mL was given bilater-ally),and the three groups were compared in terms of the VAS scores of postoperative analgesia at 4,8,12,24 and 48 h,the occurrence of the incidence of adverse reactions,such as dizziness,drowsiness,nausea,and vomi-ting,and the satisfaction with the analgesia.satisfaction of analgesia.Results Comparison of analgesic effect between groups,the VAS of group B and group C were significantly lower than those of group A at 4,8 and 12 h after surgery(P＜0.05),but there was no significant difference between group B and group C in pain scores(P＞0.05),and postoperative 24,48 h pain scores of the three groups are not statistically different(P＞0.05).In terms of the incidence of adverse reactions such as dizziness,drowsiness,nausea and vomiting,there was no significant difference in the incidence of adverse reactions between the group A and the group B,and they were all higher than that of the group C.Satisfaction with analgesia at 4,8,12,24,48 h after surgery:group C＞group B＞group A.Conclusion The multi-mode analgesia program of butorphanol intravenous an-algesia combined with transversal abdominis plane block can be safely and effectively used for postoperative analgesia after cesarean section,and appropriate reduction of butorphanol dosage when combined can alleviate the adverse reactions brought by opioids,thus improving the satisfaction of patients with postoperative analge-sia.

Objective:To explore the relationship between level of urinary iodine excretion (UIE) before 131I treatment and excellent response (ER) in low-to-intermediate risk differentiated thyroid carcinoma (DTC) patients. Methods:A retrospective analysis was performed with 432 DTC patients (124 males, 308 females, age: (42.1±11.0) years) who were treated with 131I for the first time after total thyroidectomy from June 2017 to October 2018 in Department of Nuclear Medicine, the Second Hospital of Shandong University. All patients were divided into 4 groups: G1, group 1, UIE<50 μg/L; G2, group 2, 50 μg/L≤UIE<100 μg/L; G3, group 3, 100 μg/L≤UIE<200 μg/L; G4, group 4, UIE≥200 μg/L. Patients were given 131I with a fixed dose (3 700 MBq). Response was evaluated 6 to 8 months after 131I treatment: ER, indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR). χ2 test and Kruskal-Wallis rank sum test were used to analyze the data. The adjusted standardized residual (residual) and Cramer′s V between G1-G4 and different treatment reactions were calculated to judge the difference among groups. IDR, BIR and SIR were classified into non-ER (NER) group, and binary logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to find the influencing factors of treatment reactions. Results:There were 51.9%(41/79), 64.9%(98/151), 53.8%(63/117), 30.6%(26/85) patients achieved ER in G1-G4, and the proportion of G4 was significantly lower than that of G1-G3 ( χ2 values: 7.695-25.697, all P<0.05), and there was no significant difference among G1-G3 ( χ2 values: 0.072-3.667, all P>0.05). The UIE level of patients in ER, IDR, BIR, SIR group was 87.5(57.0, 129.0), 97.0(55.7, 211.5), 141.0(74.0, 231.0), 148.0(68.5, 221.0) μg/L( H=15.977, P=0.001), and there was significant difference between those of patients in ER and SIR groups ( χ2=8.729, P=0.019). There was a certain correlation between UIE levels and different treatment reactions (Cramer′s V=0.151, P=0.001). UIE (≥200 μg/L), gender and preablative stimulated thyroglobulin could be used as independent factors affecting ER ( Wald values: 4.029, 7.185, 56.301, all P<0.05). Conclusion:Among DTC patients with low-to-intermediate risk, 131I treatment does not affect ER when the UIE level is less than 200 μg/L, while 131I treatment should be performed carefully when the UIE level is more than 200 μg/L.

OBJECTIVETo explore the effects of exogenous carbon monoxide-releasing molecules 2 (CORM-2) on LPS-induced abnormal activation of platelets in peripheral blood of healthy human donors and its possible molecular mechanism.

METHODSVenous blood samples were collected from a healthy volunteer, and platelet-rich plasma (PRP) from the blood were isolated by differential centrifugation. The PRP was subpackaged into siliconized test tubes and then divided into control group, LPS group, inactive CORM-2 (iCORM-2) group, 10 µmol/L CORM-2 group, and 50 µmol/L CORM-2 group according to the random number table, with 3 tubes in each group. The PRP in control group did not receive any treatment. The PRP in LPS group received LPS (20 mL, 10 µg/mL) stimulation, and the PRP in iCORM-2 group, 10 µmol/L CORM-2 group, and 50 µmol/L CORM-2 group underwent the same LPS stimulation and treatment of 50 µmol/L iCORM-2, 10 µmol/L CORM-2, and 50 µmol/L CORM-2, respectively, with the dosage of 20 mL. After being cultured for 30 min, the platelet adhesion rate was determined by glass bottle method, the number of platelet spreading on fibrinogen was determined with immunofluorescent method, and the platelet aggregation rate was measured by turbidimetric method. The platelet poor plasma (PPP) was prepared from PRP, the levels of ATP in PPP and platelets were determined by chemical fluorescein method. The expressions of platelet glycoprotein I bα (GPIbα) and GPVI were analyzed by flow cytometer. The expressions of glycogen synthase kinase 3β (GSK-3β) and phosphorylated GSK-3β were determined by Western blotting and immunoprecipitation, respectively. Measurement of the above indices was repeated for 3 times. Data were processed with one-way analysis of variance and SNK test.

RESULTSCompared with those in control group, the platelet adhesion rates, numbers of platelets spreading on fibrinogen, platelet aggregation rates, expressions of GPIbα and GPVI in PRP, levels of ATP in PPP in LPS and iCORM-2 groups were significantly increased, while levels of ATP in platelets were significantly decreased (with P values below 0.05). Compared with those in LPS group, the former 7 indices in iCORM-2 group showed no significant differences (with P values above 0.05), while the levels of ATP in platelets in the 10 µmol/L CORM-2 and 50 µmol/L CORM-2 groups were significantly increased, and the other 6 indices in 10 µmol/L CORM-2 and 50 µmol/L CORM-2 groups were significantly decreased (with P values below 0.05). The expression levels of GSK-3β of the platelets in PRP in control, LPS, iCORM-2, 10 µmol/L CORM-2, and 50 µmol/L CORM-2 groups were 0.550 ± 0.060, 1.437 ± 0.214, 1.210 ± 0.108, 0.720 ± 0.010, and 0.670 ± 0.010, respectively, and the expression levels of the phosphorylated GSK-3β of the platelets in PRP in the above 5 groups were 0.950 ± 0.070, 1.607 ± 0.121, 1.420 ± 0.040, 1.167 ± 0.015, and 0.513 ± 0.122, respectively. Compared with those in control group, both the expression levels of GSK-3β and phosphorylated GSK-3β of the platelets in PRP in LPS and iCORM-2 groups were significantly increased (with P values below 0.05). The expression levels of GSK-3β and phosphorylated GSK-3β of the platelets in PRP between LPS group and iCORM-2 group were similar (with P values above 0.05). The expression levels of GSK-3β and phosphorylated GSK-3β of the platelets in PRP in 10 µmol/L CORM-2 and 50 µmol/L CORM-2 groups were significantly decreased compared with those in LPS group (with P values below 0.05).

CONCLUSIONSLPS stimulation can abnormally activate the platelets in peripheral blood of healthy human, but the abnormal activation can be inhibited by CORM-2 intervention, and the mechanism of the latter may involve the phosphorylation of GSK-3β mediated by GP.

Blood Platelets ; drug effects ; metabolism ; Carbon Monoxide ; metabolism ; Glycogen Synthase Kinase 3 ; Glycogen Synthase Kinase 3 beta ; Humans ; Lipopolysaccharides ; pharmacology ; Organometallic Compounds ; pharmacology ; Phosphorylation ; drug effects ; Platelet Activation ; drug effects ; Platelet Aggregation ; drug effects ; Platelet-Rich Plasma

Objective Replacement of dexmedetomidine with propofol for maintaining the anes-thesia in elderly patients undergoing laparoscopic cholecystectomy.Methods Ninety patients,over 70 years old,undergoing laparoscopic cholecystectomy were randomly divided into 2 groups,propofol combined with remifentanil (group A),dexmedetomidine combined with remifentanil (group B),45 patients in each group.Group A was not treated with any preoperative medication,while group B was treated with loading dose of 0.5 μg/kg dexmedetomidine intravenously completed within 10 minutes. Induction methods were same in both groups,3 # or 4 # laryngeal mask were inserted after induction in both groups.Maintenance of anesthesia in group A treated with propofol 2.0-3.0 μg/ml + 4.5-5.5 ng/ml TCI;Maintenance of anesthesia in group B treated with dexmedetomidine 0.25 μg·kg-1·h-1 +remifentanil 4.5-5.5 ng/ml (TCI).HR,SBP,DBP,BIS were recorded at inserting the LMA (T1 ), beginning of the surgery (T2 ),dissociate the cholecyst (T3 ),withdrawal of the laparoscope (T4 ), extubate the LMA (T5 ).Postoperative recovery time,Steward awakening score and modified OAA/S score at extubation time were recorded.Results No significant difference was found between BIS val-ue of two groups at different time point.Compared with group A,HR at T1-T5 in group B were sig-nificantly lower,SBP,DBP were significantly decreased (P <0.05).There was no significant differ-ence between Steward awakening score and modified OAA/S score at recovery and extubation time in two groups.Conclusion Dexmedetomidine replacing propofol can be safely used in laparoscopic chole-cystectomy with less hemodynamic changes during maintenance of anesthesia in elderly patients.