Objective To explore the application and efficacy of glucocorticoids in severe non-antineoplastic drug-induced liver injury (DILI). Methods A retrospective study was conducted on patients with severe non-antineoplastic DILI who were hospitalized at Zhongshan Hospital, Fudan University from November 2016 to October 2025. Clinical data, laboratory results, suspected causative drugs, glucocorticoid use, and prognosis were collected. The time for peak total bilirubin decreased by 50% was used as an efficacy indicator. Patients were divided into a glucocorticoid group and a non-glucocorticoid group based on glucocorticoid use. Results A total of 102 patients with severe DILI were included, and 58 (56.9%) received glucocorticoid therapy. The most common suspected causative drugs were traditional Chinese medicine (65.7%), and the primary type of liver injury was hepatocellular (72.5%). The proportion of female patients (P＝0.030), baseline peak total bilirubin (P＜0.001), and international normalized ratio (P＝0.034) were significantly higher in the glucocorticoid group than in the non-glucocorticoid group. The median time for peak total bilirubin decreased by 50% was 9.5 days in the glucocorticoid group and 11 days in the non-glucocorticoid group, with no statistically significant difference between the two groups. No significant benefit of glucocorticoid therapy was observed in subgroups with positive autoantibodies, elevated immunoglobulin G (IgG), or elevated γ-globulin ratio. Low-dose and gradual tapering were the main methods of glucocorticoid administration. Adverse reactions occurred in 8 patients (13.8%) in the glucocorticoid group, which resolved after drug withdrawal or symptomatic treatment. Conclusions The usage rate of glucocorticoids is relatively high in patients with severe non-antineoplastic DILI. Glucocorticoid treatment may accelerate the improvement of cholestasis in these patients, with mild adverse reactions and good safety.

With the deepening of the reform of the medical and health system,the high-quality development of public hospitals has put forward higher requirements for the modern management system.This article takes a top-tier hospital in Huai'an as an example to explore the practical path and effectiveness of constructing a target management system for department directors in large public hospitals.The research achieved a comprehensive improvement in management efficiency by building a multi-di-mensional discipline evaluation system,promoting the construction of key specialties,creating a'trinity'medical quality man-agement system,strengthening the construction of quality control centers,and combining personalized target management respon-sibility agreements with the selection mechanism for outstanding department directors.Over the three years of implementation,key indicators of the hospital,such as the number of key specialties,CMI value,proportion of fourth-level surgeries,and average length of stay,have significantly improved.The research shows that this system,through the synergistic effect of goal orientation and performance incentives,effectively promotes the coordinated development of discipline construction,medical quality,and op-erational efficiency,providing a reference management paradigm for public hospitals to transition from scale expansion to connota-tion enhancement.

With the deepening of the reform of the medical and health system,the high-quality development of public hospitals has put forward higher requirements for the modern management system.This article takes a top-tier hospital in Huai'an as an example to explore the practical path and effectiveness of constructing a target management system for department directors in large public hospitals.The research achieved a comprehensive improvement in management efficiency by building a multi-di-mensional discipline evaluation system,promoting the construction of key specialties,creating a'trinity'medical quality man-agement system,strengthening the construction of quality control centers,and combining personalized target management respon-sibility agreements with the selection mechanism for outstanding department directors.Over the three years of implementation,key indicators of the hospital,such as the number of key specialties,CMI value,proportion of fourth-level surgeries,and average length of stay,have significantly improved.The research shows that this system,through the synergistic effect of goal orientation and performance incentives,effectively promotes the coordinated development of discipline construction,medical quality,and op-erational efficiency,providing a reference management paradigm for public hospitals to transition from scale expansion to connota-tion enhancement.

Objective:To explore the drugs and clinical characteristics causing drug-induced liver injury (DILI) in recent years, as well as identify drug-induced liver failure, and chronic DILI risk factors, in order to better manage them timely.Methods:A retrospective investigation and analysis was conducted on 224 cases diagnosed with DILI and followed up for at least six months between January 2018 and December 2020. Univariate and multivariate logistic regression analyses were used to identify risk factors for drug-induced liver failure and chronic DILI.Results:Traditional Chinese medicine (accounting for 62.5%), herbal medicine (accounting for 84.3% of traditional Chinese medicine), and some Chinese patent medicines were the main causes of DILI found in this study. Severe and chronic DILI was associated with cholestatic type. Preexisting gallbladder disease, initial total bilirubin, initial prothrombin time, and initial antinuclear antibody titer were independent risk factors for DILI. Prolonged time interval between alkaline phosphatase (ALP) and alanine aminotransferase (ALT) falling from the peak to half of the peak (T 0.5ALP and T 0.5ALT) was an independent risk factor for chronic DILI [area under the receiver operating characteristic curve (AUC)?=?0.787, 95%CI: 0.697~0.878, P ?

Objective:To preliminarily disclose the biological properties of recombinant human tau441 (P301S) protein, such as aggregation, antigenicity and immunogenicity.Methods:The recombinant plasmid tau441 (P301S) was expressed by prokaryotic expression system and purified by nickel column affinity chromatography. The protein concentrations were determined via BCA kit. The purity of protein was determined by SDS-PAGE gel coomassie brilliant blue staining. Western blot (WB) and negative staining transmission electron microscopy (TEM) were used to identify the recombinant proteins. The antigenicity was detected through indirect enzyme linked immunosorbent assay (ELISA), and the immunogenicity was detected by specific antibody titers of mouse immune serum.Results:The purity of recombinant human tau441 (P301S) was 70%. WB showed specific bands at relative molecular mass (Mr.×10 3) 64 and higher relative molecular mass. Negative staining TEM showed that tau441 (P301S) was aggregated, and the area was significantly larger than tau wild-type control protein (t=6.439, P=0.003). After 9 days of incubation at 4 ℃, tau441 (P301S) formed obvious fibrotic structure. Indirect ELISA result showed that tau441 (P301S) could be recognized by anti-tau monoclonal antibody HT7 (1∶80 000). The specific antibody titer of the immunized serum was 1∶128 000 and WB showed that the immunized serum recognized the brain lysate extract of Alzheimer’s disease (AD) transgenic mice. Conclusions:The recombinant human tau441 (P301S) protein had the characteristics of enhanced aggregation in vitro, but its antigenicity and immunogenicity were not changed.

Objective: To retrospectively analyze the efficacy and prognostic factors of postoperative intensity modulated radiotherapy for grade Ⅱ gliomas. Methods: Retrospective analysis was conducted on patients with postoperative grade Ⅱ glioma in our hospital from Jan. 2010 to Dec. 2018. The primary endpoint was progression-free survival, and the secondary endpoint was overall survival. Correlative analyses of prognosis by age, gender, initial resection status, the maximum diameter of the lesions, bi-hemisphere, astrocytoma, chemoradiation, adjuvant chemotherapy were conducted. Results: A total of 109 cases with grade Ⅱ glioma were enrolled. The follow-up rate was 91.75%, including 10 cases dead and 27 relapsed. There were 24 cases (88.9%) of in-field failure, and 3 cases (11.1%) of out-field failure. 14 cases of recurrence occurred in 81 cases of total resection group, accounting for 17.3%, and 13 in 28 cases of subtotal resection group, accounting for 46.4%. The recurrence rate in the subtotal resection group was significantly higher than that in the total resection group (χ ²=9.484, P<0.05). The 1-, 2-, 3-, 4- and 5-year progression-free survival rates were 92.5%, 86.0%, 80.6%, 77.5% and 66.8%, respectively. The 2-, 3-, 4- and 5-year overall survival rates were 97.2%, 90.8%, 87.7% and 84.5%, respectively. Multivariate analysis showed that patients with subtotal resection(HR=3.608, P<0.05) and bi-hemisphere(HR=3.183, P<0.05)were significantly correlated with the progression free survival. Conclusions Postoperative intensity modulated radiotherapy for grade Ⅱ gliomas can achieve a better PFS. Recurrence in the radiation field is the main failure mode. Initial resection status and bi-hemisphere of tumor are important influential factors for PFS of grade Ⅱ gliomas patients.

Objective:To investigate whether adjuvant skin-marker positioning can decrease the set-up errors in overweight patients with thoracic and abdominal tumors.Methods:A total of 60 overweight patients with thoracic and abdominal tumors treated with radiotherapy in the First Affiliated of Fujian Medical University between January 2018 and December 2018 were randomly divided into two groups. In group A, conventional skin-marker positioning was adopted. In group B, conventional skin-marker positioning combined with adjuvant skin-marker position was employed. All patients were immobilized with thermoplastic positioning body membrane with head-body plate fixation. The set-up errors in the right-left, head-foot and dorsoventral directions were obtained from cone-beam CT (CBCT) scan system before radiation delivery. The set-up errors were statistically compared between two groups by using t-test. Results:In group A, the set-up errors in the right-left, head-foot and dorsoventral directions were (4.47±2.91) mm, (5.43±2.61) mm and (3.87±2.40) mm, significantly higher compared with (2.97±1.68) mm, (3.21±1.62) mm and (2.59±1.57) mm, respectively (all P<0.001). Conclusion:Adjuvant skin-marker positioning method can reduce the set-up errors and enhance the positioning repeatability in overweight patients with thoracic and abdominal tumors receiving radiotherapy.

Objective: To evaluate the effect of tumor shape and location on pulmonary dose-volume parameters by intensity-modulated radiation therapy (IMRT) in patients with non-small cell lung cancer (NSCLC), aiming to provide a reference basis for establishing limits of the pulmonary dose-volume parameters during IMRT. Methods: Clinical data of 208 NSCLC patients undergoing radical IMRT from June 2009 to June 2016 were retrospectively analyzed. According to the tumor shape and location, 208 cases were divided into the vertical bar group (n=127) and the horizontal bar group (n=81), the superior lung group (n=103) and the inferior lung group (n=105). Regression model curve was used to evaluate the effect of tumor shape and location upon the common pulmonary dose-volume parameters(V₅, V₂₀, MLD, AVS₅ and AVS₂₀). Results: In all groups, the fitting curves of V₅, V₂₀ and MLD were manifested in the quadratic equation pattern, and AVS₅ and AVS₂₀ in the logarithmic equation manner. In the vertical bar group, the V₅(P=0.015), V₂₀(P=0.047) and MLD (P=0.012) were significantly higher, whereas the AVS₅(P=0.044) was significantly lower compared with those in the horizontal bar group. No statistical significance was observed in AVS₂₀ between two groups (P=0.490). The tumor location exerted significant effect upon V₅ alone (P=0.009). Conclusions When the tumors presents in the vertical bar shape, the limits of the common lung dose-volume parameters are likely to exceed those of tumors in the vertical bar shape. Lung tumors located in the inferior lobe exerts a more significant effect upon the low-dose region volume compared with the tumors in the superior lobe.

Theof(for short) was officially published as a standard of China Association of Acupuncture and Moxibustion in 2015. From the purpose, methodology, scope, indication, recommended protocol, etc., this was explained to provide convenience for clinical use of acupuncturists. Thiswas developed based oncomprehensive search of literature regarding acupuncture for periarthritis of shoulder, the adoption of best evidence, expert experience, patient value across the world, methods of evidence quality and GRADE, references of clinical experience of famous acupuncturists in the ancient and modern time and expert consensus in the national level, which was hoped to provide solid evidence of acupuncture clinical treatment for periarthritis of shoulder to ensure the safety and effectiveness. In this, the stage-by-stage treatment principle of acupuncture for periarthritis of shoulder was recommended. In the acute stage, the treatment aim was to relieve the pain, and distal acupoints along the meridians were selected with strong stimulation; the local acupoints were combined. In the chronic stage and rehabilitation stage, the treatment aim was to improve the dysfunction of shoulder joint, and acupuncture treatment was based on syndrome differentiation of etiology and meridian; the local acupoints were mainly selected, combined with acupoints based on etiology and acupoints along meridians.

Objective To analyze the efficacy and prognostic factors of postoperative radiotherapy for high grade gliomas based on MRI guided target delineation. Methods Retrospective analysis was conducted on 111 patients with high-grade gliomas from October 2010 to December 2015. The patients were treated with IMRT in combination with temozolomide guided by MRI-CT fusion technique after target delineation at preoperation, postoperation ( < 72 h ) and before radiotherapy. The survival rate was calculated by K-M method. The analyses of single factor and multiple factor, ranging from the patients′age, gender, pathological grade, number of lesions, multiple lobes, tumour crossing the midline,epilepsy, the maximum diameter of the lesions, adjuvant chemotherapy and other factors on prognosis were conducted with Log-Rank test and COX regression analysis. Results A total of 111 patients met the criteria for admission, and the overall follow-up rate was 94. 6%. The survival rates of 1-, 2-, 3-, 4-, 5- year were 81. 6%, 54. 2%, 39. 1%, 25. 4%, 15. 5%, respectively. The median survival time was 38 months. The single factor analysis showed that pathological grading (χ2 =5. 549, P<0. 05), age (χ2 =6. 393, P<0. 05), preoperative tumor maximum diameter (χ2 =4. 555, P<0. 05) and adjuvant chemotherapy (χ2 =4. 965, P <0. 05 ) were correlated with on the survival rate, while multivariate analysis showed that pathological grade Ⅲ, younger age, preoperative tumor with size smaller contributed to the good prognosis (Wald=4. 784, 4. 560, 5. 859, P<0. 05). Conclusions High grade gliomas after operation by MRI-CT fusion technique in preoperative and postoperative 72 h and MRI before radiotherapy guided by radiotherapy, for intensity-modulated radiotherapy combined with temozolomide chemotherapy, can obtain better efficacy. The grade Ⅲ of glioma, <50 years old, the maximum diameter of the tumor <6 cm, the adjuvant chemotherapy may have the better prognosis.