OBJECTIVE To explore the transformation of the dispensing and drug pickup process in traditional Chinese medicine pharmacy （TCM Pharmacy） in our hospital based on data-intelligence-driven， aiming to improve pharmacists’ work efficiency and patients’ drug pickup experience. METHODS Value stream mapping and journey mapping were used to systematically identify non-value-added links in pharmacists’ dispensing process and key pain points in patients’ drug pickup under the traditional process. An intelligent dispensing and drug pickup system for the TCM Pharmacy was developed based on the C# and Android television platforms， and a machine-learning model was adopted to predict patients’ drug pickup waiting time. A comprehensive evaluation was performed from three perspectives： system performance， prediction accuracy， and satisfaction of pharmacists and patients. RESULTS The system successfully streamlined non-value-added links such as “waiting for writing on the board” and “searching for drugs”， and realized multimodal dynamic prompts of dispensing status through auditory （number calling） and visual （television terminal） channels. The constructed model for predicting drug pickup waiting time exhibited good fitting degree and generalization ability （mean absolute error＝4.28 min， R 2 ＝0.882）. The comprehensive satisfaction scores of pharmacists and patients in the traditional mode were significantly increased from （70.99±1.74） and （73.58±1.98） to （90.02±1.30） and （88.61±2.08） in the new system， respectively （ P ＜0.01）. CONCLUSIONS The transformation of the intelligent drug dispensing and pickup system for TCM pharmacy based on data-intelligence-driven effectively improves the efficiency of pharmacists’ dispensing work， realizes process transparency and waiting time predictability， and significantly enhances patients’ drug pickup experience.

Since the founding of the People’s Republic of China, remarkable achievements have been gained in infectious disease prevention and control, and rich practical experiences have been accumulated. If these experiences are shared with developing countries, it will greatly contribute to global infectious disease control and global health security. Under the framework of Forum on China-Africa Cooperation, a series of China-Africa public health capacity training programs have been recently held in China, in order to help improve the capability of infectious disease control in African countries. This article summarized and refined good design concepts and practices from these programs, so as to provide insights into sustainable optimization of China-Africa public health capacity training and improvements of the training effectiveness.

Background: and Purpose Therapeutic target selection in noninvasive brain stimulation for poststroke motor recovery typically relies on the interhemispheric inhibition model, which is effective for mildly affected patients but offers limited benefits for severely affected individuals. The mechanisms governing recovery from moderate-to-severe stroke remain poorly understood, which hinders the development of targeted interventions. Methods: We analyzed resting-state functional magnetic resonance imaging data from patients with unilateral subcortical stroke and moderate-to-severe upper limb deficits, both pre- and postintervention, along with data from healthy controls. We developed a novel dynamic lag analysis method for identifying recovery-related homotopic sensorimotor regions with altered interhemispheric interactions. To further uncover the global reorganization pathway, we developed dynamic lateralization approaches to detect large-scale functional connectivity (FC) alterations associated with the identified regions in transient lateralization states. Results: Dynamic time-lag analysis revealed significantly reduced synchronized states in the homotopic dorsal premotor cortex (PMd) post-intervention compared with pre-intervention, which correlated with motor recovery. Further dynamic lateralization analysis revealed a prolonged segregation state in patients, characterized by weakened interhemispheric and strengthened intrahemispheric interactions. In this state, patients showed decreased FC in the ipsilesional PMd and increased FC in the contralesional PMd with bilateral subcortical networks. These recoveryrelated alterations were absent in the traditional static analysis. Conclusions Dynamic analyses targeting interhemispheric interactions are valuable for understanding neural reorganization after stroke. The diminished interactions between the homotopic PMd indicate a compensatory mechanism. Importantly, a state-dependent compensatory pathway was identified, wherein the contralesional PMd assumes the functions of the ipsilesional PMd through enhanced interactions with subcortical structures, potentially guiding more effective interventions.

Objective:To systematically evaluate the risk prediction models for refeeding syndrome in critically ill patients in China and abroad, with the aim of providing feasible risk assessment tools for clinical healthcare professionals.Methods:A computerized search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL, Proquest, Scopous, China Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP was conducted for relevant literature from database inception to July 1, 2024. Two researchers independently reviewed the literature and extracted the relevant information. Quality assessment was performed using a risk of bias assessment tool specifically designed for predictive modeling.Results:A total of 8 papers were included, reporting 8 risk prediction models for refeeding syndrome in critically ill patients, with sample sizes ranging from 109 to 806 cases, outcome event rates from 22.5% to 69.8%, and area under the curve values from 0.74 to 0.95. The most frequently reported predictors included albumin (ALB), pre-albumin (PAB), blood potassium, use of diuretics, and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores.Conclusions:The risk prediction models for refeeding syndrome in critically ill patients have good predictive performance but are still in the development stage. A high-quality, low-bias clinically applicable model should be established through multicenter, large-sample, and standardized studies.

Objective To understand the economic losses due to healthcare-associated infection(HAI)in patients after Da Vinci robotic thoracic surgery,and provide basis for preventing and controlling HAI after robotic surgery.Methods Patients who underwent Da Vinci robotic surgery from April 2019 to April 2023 were retrospective stu-died.Patients were divided into HAI group and non-HAI group based on the occurrence of postoperative infection.Through 1∶1 propensity score matching(PSM),31 cases were included in each group,economic losses of two groups of patients were compared.Results A total of 921 patients who underwent Da Vinci robotic thoracic surgery were included in the study,51 cases with HAI(HAI group)and 870 without HAI(non-HAI group).After 1∶1 PSM,31 cases were included in each group.Four covariates were compared between two groups of patients before PSM,namely gender,age,comorbidities,and the American Society of Anesthesiologists(ASA)grading,all with statistically significant differences(all P＜0.05).After PSM,distribution of the above covariates reached equilib-rium between the two groups(both P＞0.05).The median total expense for HAI group before PSM during hospi-talization was 88 711.72 Yuan,while 78 509.46 Yuan for the non-HAI group.The direct economic losses caused by HAI after Da Vinci robot surgery was 10 202.26 Yuan,mainly increased by expense of medicine,nursing,laborato-ry diagnosis,etc.Difference in western medicine expense was the highest(8 839.12 Yuan),out of which expense of antimicrobial agents accounted for the highest proportion(73.55％).Difference in daily hospitalization expense between HAI-group and non-HAI group was 502.38 Yuan.Length of hospital stay of patients in HAI group and non-HAI group were(21.59±10.62)and(13.92±9.21)days,respectively,with statistical differences(all P＜0.05).Conclusion The occurrence of HAI in patients undergoing Da Vinci robotic thoracic surgery leads to direct economic losses,with obvious increases in expenses of nursing,laboratory diagnosis,western medicine(mainly an-timicrobial agents).Length of hospital stay of patients also prolongs.

Objective:To develop a journey map for health management of patients with disability caused by accidental trauma from the social ecosystem theory perspective, so as to gain deeper insights into their actual needs during medical treatment and rehabilitation.Methods:The descriptive qualitative research was adopted. Purposeful sampling was employed to select patients with disability caused by accidental trauma admitted to the Trauma Center of the Department of Emergency and Critical Care Medicine at the First Affiliated Hospital with Nanjing Medical University between April and May 2024 for semi-structured interviews. Traditional content analysis method was employed to analyze the interview data.Results:From three dimensions of microsystem, mesosystem, and macrosystem, the needs and potential issues of medical treatment at different stages of the health management process for patients with disability caused by accidental trauma were analyzed, forming a patient journey map.Conclusions:Patients with disability caused by accidental trauma face prolonged periods of medical treatment, rehabilitation, and lifestyle readjustment, imposing significant burdens on themselves, their caregivers, and their families. Healthcare providers may proactively engage with patients based on their current and potential issues and needs, offer specialized guidance at critical junctures and meet the need of patients for continuity of care, thereby improving patients' quality of life and overall health outcomes.

Objective Using network pharmacology research methods and animal pharmacology experiments,explore the mechanism of antidepressant effects of traditional Chinese medicine Citron and Bergamot.Methods Using the Traditional Chinese Medicine System Pharmacology Database and Analysis Platform(TCMSP),ETCM,Symmap,Swiss Target Prediction,and Uniprot data platforms,screen the active ingredients and corresponding gene targets of Citron and Bergamot.Obtain depression gene targets using OMIM,TTD,and Cenecards data platforms.Using Venny 2.1 online software,draw Venn diagrams of the intersection of active ingredients and gene targets.Draw network diagrams between drugs,active ingredients,targets,and diseases using Cytoscape 3.7.2 software.Construct a protein-protein interaction(PPI)network diagram using the STRING data platform for intersecting genes.Using the Metascape data platform,perform gene ontology(GO)function and Kyoto Encyclopedia of Genesand and Genomes(KEGG)pathway enrichment analysis.A rat depression model was established using chronic unpredictable mild stress(CUMS)combined with solitary care,and animal experiments were conducted to verify the BDNF/TrkB/CREB signaling pathway obtained from network pharmacology research.Results The research results of network pharmacology methods show that there are 57 antidepressant active ingredients in Citron,65 antidepressant active ingredients in Bergamot,and important active ingredients include Acetic acid,3,4,7-trimethoxycoumarin and Citric acid,etc.Through the data platform,2717 depression targets and 430 intersection targets were identified.Through PPI network analysis,key gene targets for antidepressant effects in Citron and Bergamot were identified,including TP53,Protein kinase B1,CREB-binding protein,Brain derived neurotrophic factor,etc.Through KEGG analysis,it was found that important signaling pathways include pathways in cancer,PI3K-Akt signaling pathway,Neurotrophin signaling pathway,etc.By observing the neurotrophic factor BDNF/TrkB/CREB signaling pathway in depressed rats,the results showed that the medium dose groups of Citron and Bergamot could significantly increase serum BDNF content(P<0.05),and each treatment group could improve the damage of hippocampal neurons in rats.The high and medium dose groups of Citron and Bergamot significantly increased the expression of BDNF protein in the hippocampal CA1 region(P<0.05,P<0.01).Except for the low-dose group,which showed no difference in TrkB mRNA gene expression,all other treatment groups significantly increased the mRNA gene expression levels of hippocampal BDNF,TrkB and CREB(P<0.01).The medium dose group of Citron and Bergamot increased the expression of BDNF protein in the hippocampus(P<0.01),while the medium and low dose groups significantly increased the relative expression of TrkB protein in the hippocampus(P<0.05).The medium dose group showed an increasing trend in the relative expression of CREB protein.Conclusion Traditional Chinese medicine Citron and Bergamot have therapeutic effects on depression models in rats,and the mechanism of action may be related to the BDNF/TrkB/CREB signaling pathway.

Objective:To develop a journey map for health management of patients with disability caused by accidental trauma from the social ecosystem theory perspective, so as to gain deeper insights into their actual needs during medical treatment and rehabilitation.Methods:The descriptive qualitative research was adopted. Purposeful sampling was employed to select patients with disability caused by accidental trauma admitted to the Trauma Center of the Department of Emergency and Critical Care Medicine at the First Affiliated Hospital with Nanjing Medical University between April and May 2024 for semi-structured interviews. Traditional content analysis method was employed to analyze the interview data.Results:From three dimensions of microsystem, mesosystem, and macrosystem, the needs and potential issues of medical treatment at different stages of the health management process for patients with disability caused by accidental trauma were analyzed, forming a patient journey map.Conclusions:Patients with disability caused by accidental trauma face prolonged periods of medical treatment, rehabilitation, and lifestyle readjustment, imposing significant burdens on themselves, their caregivers, and their families. Healthcare providers may proactively engage with patients based on their current and potential issues and needs, offer specialized guidance at critical junctures and meet the need of patients for continuity of care, thereby improving patients' quality of life and overall health outcomes.

Objective:To compare the effects of early orthodontic intervention and conventional sequential periodontal-orthodontic treatment to periodontal health in patients with stage Ⅳ periodontitis.Methods:A total of 30 patients with stage Ⅳ periodontitis, who underwent combined periodontal and orthodontic therapies at the Department of Periodontology, the Second Affiliated Hospital of Zhejiang University School of Medicine, from January 2018 to August 2024, were included. Patients who underwent early orthodontic intervention were initiated simultaneously or within one month after supragingival scaling and subgingival root planning ( n=15). While patients in control group accomplished supragingival scaling, subgingival root planning, and corresponding periodontal surgeries to achieve inflammation control before starting orthodontic treatment ( n=15). Periodontal parameters, including clinical attachment loss (CAL), probing depth (PD), and bleeding on probing (+) % [BOP (+) %], were measured at baseline, one year after orthodontic treatment, and at the end of combined periodontal-orthodontic therapy respectively. Improvements in periodontal parameters and differences in tooth loss between the two groups were compared. Results:After receiving combined periodontal-orthodontic treatment, the CAL of the early orthodontic intervention group significantly decreased from (4.39±0.90) mm before treatment to (2.41±0.35) mm at the end of treatment ( t=7.92, P<0.001). Similarly, the PD significantly reduced from (4.20±1.04) mm before treatment to (2.20±0.38) mm at the end of treatment ( t=7.01, P<0.001). The BOP(+)% also showed a significant improvement, decreasing from 89.29% (68.00%, 100.00%) before treatment to 13.04% (7.14%, 17.86%) at the end of treatment ( Z=-3.41, P<0.001). There were no statistically significant differences between the early orthodontic intervention group and control group in terms of baseline mean CAL, mean PD, and BOP(+)% ( t=1.30, P=0.205; t=1.28, P=0.212; Z=0.58, P=0.559). Furthermore, the improvements in CAL and PD between the two groups were not significantly different compared to baseline ( Z=-1.10, P=0.272; Z=-0.93, P=0.351). However, the number of missing teeth was significantly lower in the early orthodontic intervention group than in the control group (χ2=3.96, P=0.047). The duration of combined periodontal-orthodontic treatment in the early orthodontic intervention group was [33.13 (23.37, 36.20) months], which was significantly shorter than that in the control group [37.47 (32.33, 50.90) months] ( Z=2.07, P=0.037). Conclusions:Both early orthodontic intervention and conventional periodontal-orthodontic treatment significantly improved CAL, PD, and BOP(+)% in stage Ⅳ periodontitis patients. Early orthodontic intervention contributed to the preservation of natural teeth and shortened the treatment duration of stage Ⅳ periodontitis.

Objective To investigate washing patterns in human simulated body fluids(SBF)by combining high doses of vancomycin,manuperenan and single compound with bone cement.The antibacterial effect of five common bacteria in orthopaedic infections were observed.Methods Vancomycin 2g and meropenem 3g were combined or alone mixed with ordinary bone cement 20g in aseptic operation.Six copies of antibiotic bone cement pellets were made,immersed in SBF,replaced with SBF buffer every 48 hours,sampled every 24 hours 2 μl drops in methicillin-resistant staphylococcus aureus(MRSA),petries of staphylococcus aureus,pseudomonas aeruginosa,E.coli,and extended-spectrum beta-lactamase(ESBL)-positive E.coli were observed for 24 hours and measured the size of the bactericidal rings of the washing fluid at each time point.The antibacterial effect of different ratios of antibiotic bone cement on 5 common orthopedic infections were compared.Results Compound antibiotic group had a better bactericidal effect,and the drug continues to be given for about 30 days.Wancomycin alone could not cover E.coli,ESBL positive E.coli,pseudomonas aeruginosa,and melopicillin alone had only a partial mild bactericidal effect on MRSA around 3 to 6 days after use.The effect on staphylococcus aureus and pseudomonas aeruginosa lasted only about 15 days.Conclusion The combined antibiotic bone cement has a more comprehensive,longer duration and better bactericidal effect than the alone antibiotic bone cement.