OBJECTIVE To establish the precise management model for the centralized preparation of cytotoxic drugs in pharmacy intravenous admixture services(PIVAS),and evaluate the effects of its application.METHODS Pharmacists in PIVAS established the precise management model by soliciting clinical opinions and consulting literature on the centralized preparation of cytotoxic drugs and continuously refining every step of the preparation of cytotoxic drugs,based on data feedback from the information closed-loop management system and the limit of stability time of finished solutions.The indicators such as the preparation time,delivery time,the storage time of finished infusion solutions after preparation,and the completion rate of infusion within the stability time limit were analyzed before the implementation(January to December 2023)and after the implementation(January to December 2024)of this model,to evaluate its application effectiveness.RESULTS The overall framework for the precise management model included upgrading the functions of the prescription review system,improving the prescription review database,providing specialized training for PIVAS pharmacists,managing dynamic batch decision for drug preparation,managing special drugs,managing finished infusion distribution,and establishing a continuous improvement mechanism.Compared with before implementation,the average preparation time of the second and third batches of cytotoxic drugs with more concentrated morning preparation tasks in this model was significantly shorter than before implementation(P＜0.05);the delivery time of finished infusion after implementation[(11.49±2.92)min]was significantly shorter than the delivery time before implementation[(22.11±5.03)min](P＜0.001);the storage time of some drugs with shorter stable time limit and carboplatin in combination regimens(paclitaxel or docetaxel+carboplatin)was significantly shortened compared to before implementation(P＜0.05),and the completion rate of infusion within the stability time limit was significantly improved compared to before implementation(P＜0.05).CONCLUSIONS Our hospital has successfully established a precise management model for the centralized preparation of cytotoxic drugs in PIVAS.This mode can significantly shorten the preparation time of each batch of PIVAS in the morning,make batch decisions more reasonable and improve the infusion completion rate within the stable time limit of the finished product.

BACKGROUND: Treatment with chimeric antigen receptor-T (CAR-T) cells has shown promising effectiveness in patients with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL), although the process of preparing for this therapy usually takes a long time. We have recently created CD19 Fast-CAR-T (F-CAR-T) cells, which can be produced within a single day. The objective of this study was to evaluate and contrast the effectiveness and safety of CD19 F-CAR-T cells with those of CD19 conventional CAR-T cells in the management of R/R B-ALL. METHODS: A multicenter, retrospective analysis of the clinical data of 44 patients with R/R B-ALL was conducted. Overall, 23 patients were administered with innovative CD19 F-CAR-T cells (F-CAR-T group), whereas 21 patients were given CD19 conventional CAR-T cells (C-CAR-T group). We compared the rates of complete remission (CR), minimal residual disease (MRD)-negative CR, leukemia-free survival (LFS), overall survival (OS), and the incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) between the two groups. RESULTS: Compared with the C-CAR-T group, the F-CAR-T group had significantly higher CR and MRD-negative rates (95.7% and 91.3%, respectively; 71.4% and 66.7%, respectively; P = 0.036 and P = 0.044). No significant differences were observed in the 1-year or 2-year LFS or OS rates between the two groups: the 1-year and 2-year LFS for the F-CAR-T group vs.C-CAR-T group were 47.8% and 43.5% vs. 38.1% and 23.8% (P = 0.384 and P = 0.216), while the 1-year and 2-year OS rates were 65.2% and 56.5% vs. 52.4% and 47.6% (P = 0.395 and P = 0.540). Additionally, among CR patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) following CAR-T-cell therapy, there were no significant differences in the 1-year or 2-year LFS or OS rates: 57.1% and 50.0% vs. 47.8% and 34.8% (P = 0.506 and P = 0.356), 64.3% and 57.1% vs. 65.2% and 56.5% (P = 0.985 and P = 0.883), respectively. The incidence of CRS was greater in the F-CAR-T group (91.3%) than in the C-CAR-T group (66.7%) (P = 0.044). The incidence of ICANS was also greater in the F-CAR-T group (30.4%) than in the C-CAR-T group (9.5%) (P = 0.085), but no treatment-related deaths occurred in the two groups. CONCLUSION Compared with C-CAR-T-cell therapy, F-CAR-T-cell therapy has a superior remission rate but also leads to a tolerably increased incidence of CRS/ICANS. Further research is needed to explore the function of allo-HSCT as an intermediary therapy after CAR-T-cell therapy.

Objective:To investigate the efficacy of computed tomographic angiography (CTA) three-dimensional reconstruction technology in the repair of limb wounds using free double-leaf anterolateral thigh perforator flaps.Methods:A retrospective analysis was conducted on 30 patients with varying degrees of skin damage on their limbs who were admitted to the Hand and Foot Surgery Department of Yiwu Central Hospital in Zhejiang Province and Zhejiang Provincial People's Hospital from January 2015 to March 2022. The patients were divided into observation group ( n=15) and control group ( n=15) based on whether CTA three-dimensional reconstruction was performed preoperatively. In the observation group, CTA three-dimensional reconstruction was performed preoperatively, including 9 males and 6 females, aged 17-67 (49.7±4.2) years. In the control group, handheld Doppler ultrasound angiography was performed preoperatively, including 10 males and 5 females, aged 20-69 (50.4±5.0) years. Relevant intraoperative and postoperative indicators were compared between the two groups, including operation duration, anesthesia recovery time, blood loss, perforator localization accuracy, vascular anastomosis rate between the donor and recipient sites, flap harvesting time, flap survival rate, and incidence of adverse reactions. Follow-up visits were conducted via telephone or outpatient clinic for 3 months postoperatively, with one visit per month, to assess patient satisfaction rates. A multi-criteria decision-making model was established, and the benefit values, risk values, and stability of the decision-making model were evaluated for both groups. Results:Compared with the control group, the observation group had significantly reduced operation duration, anesthesia recovery time, blood loss, and flap harvesting time (all P<0.05). The patient satisfaction rate, perforator localization accuracy, and vascular anastomosis rate between the donor and recipient sites were significantly better in the observation group than in the control group (all P<0.05). The incidence of adverse reactions was 13.3% (2/15) in the observation group, which was lower than 53.3% (8/15) in the control group ( P=0.020). Among the benefit indicators, the vascular anastomosis rate between the donor and recipient sites and flap survival rate had the greatest impact on treatment outcomes. Among the risk indicators, venous crisis and flap necrosis had a greater impact. The benefit-risk value was 77 in the observation group and 56 in the control group, with a difference of 21 (95% CI: 14-26) between the two groups. The observation group had higher values than the control group within the range of 0-100% relative risk weight, indicating good stability of the multi-criteria decision-making evaluation model. Conclusion:CTA three-dimensional reconstruction technology can improve the vascular anastomosis rate between the donor and recipient sites and patient satisfaction rates in the repair of limb wounds using free double-leaf anterolateral thigh perforator flaps.

Objective:To investigate the efficacy of different treatment of oral lichen planus (OLP) patients with thyroid antibody positive and its correlation with thyroid antibody, providing more targeted treatment for OLP patients with thyroid antibody positive.Methods:Patients who were admitted to Department of Oral Medicine, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine for OLP with serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) from February 2020 to June 2024 were included. Demographic and clinical data were recorded, and qualitative status and quantitative titers of TPOAb/TGAb were collected. TPOAb and/or TGAb positive patients were included into the thyroid antibody positive group, while patients with both TPOAb and TGAb negative were included into the thyroid antibody negative group. According to the treatment methods, they were divided into topical treatment group, topical treatment combined with oral immunosuppressant group, and topical treatment combined with oral immunoenhancer group. After 2 weeks and 1 month of treatment, the clinical efficacy of thyroid antibody positive group and negative group in OLP patients under different treatment methods were compared, and the correlations of different clinical efficacy with age, sex and thyroid antibody titer were analyzed.Results:A total of 116 OLP patients were included in this study, of which 38 (32.8%) were thyroid antibody positive and 78 (67.2%) were thyroid antibody negative. Compared with untreated, the modified OLP score and pain degree in thyroid antibody negative group were significantly improved after 2 weeks and 1 month of topical treatment and topical treatment combined with oral immunosuppression ( P<0.01). Although the thyroid antibody positive group also showed a remission trend, there was no statistical significance before and after treatment ( P>0.05). For topical treatment combined with oral immunoenhancer, the modified OLP score and pain degree in both groups of antibody positive and negative were statistically significant different after 2 weeks and 1 month of treatment compared with before ( P<0.01), while there was no statistically significant difference between the two groups ( P>0.05). Multivariate Logistic regression analysis showed that the treatment efficacy of OLP in topical treatment group, topical treatment combined with oral immunosuppressant group, and topical treatment combined with oral immunoenhancer group had no significant correlation with age, sex, as well as the TPOAb and TGAb titer ( P>0.05). Conclusions:Thyroid antibody TPOAb and TGAb could be reference factors for the selection of OLP treatment plan. For patients of OLP with positive thyroid antibodies, topical therapy combined with oral immunoenhancers may be preferred.

Objective:To investigate the efficacy of different treatment of oral lichen planus (OLP) patients with thyroid antibody positive and its correlation with thyroid antibody, providing more targeted treatment for OLP patients with thyroid antibody positive.Methods:Patients who were admitted to Department of Oral Medicine, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine for OLP with serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) from February 2020 to June 2024 were included. Demographic and clinical data were recorded, and qualitative status and quantitative titers of TPOAb/TGAb were collected. TPOAb and/or TGAb positive patients were included into the thyroid antibody positive group, while patients with both TPOAb and TGAb negative were included into the thyroid antibody negative group. According to the treatment methods, they were divided into topical treatment group, topical treatment combined with oral immunosuppressant group, and topical treatment combined with oral immunoenhancer group. After 2 weeks and 1 month of treatment, the clinical efficacy of thyroid antibody positive group and negative group in OLP patients under different treatment methods were compared, and the correlations of different clinical efficacy with age, sex and thyroid antibody titer were analyzed.Results:A total of 116 OLP patients were included in this study, of which 38 (32.8%) were thyroid antibody positive and 78 (67.2%) were thyroid antibody negative. Compared with untreated, the modified OLP score and pain degree in thyroid antibody negative group were significantly improved after 2 weeks and 1 month of topical treatment and topical treatment combined with oral immunosuppression ( P<0.01). Although the thyroid antibody positive group also showed a remission trend, there was no statistical significance before and after treatment ( P>0.05). For topical treatment combined with oral immunoenhancer, the modified OLP score and pain degree in both groups of antibody positive and negative were statistically significant different after 2 weeks and 1 month of treatment compared with before ( P<0.01), while there was no statistically significant difference between the two groups ( P>0.05). Multivariate Logistic regression analysis showed that the treatment efficacy of OLP in topical treatment group, topical treatment combined with oral immunosuppressant group, and topical treatment combined with oral immunoenhancer group had no significant correlation with age, sex, as well as the TPOAb and TGAb titer ( P>0.05). Conclusions:Thyroid antibody TPOAb and TGAb could be reference factors for the selection of OLP treatment plan. For patients of OLP with positive thyroid antibodies, topical therapy combined with oral immunoenhancers may be preferred.

Objective:To investigate the efficacy of computed tomographic angiography (CTA) three-dimensional reconstruction technology in the repair of limb wounds using free double-leaf anterolateral thigh perforator flaps.Methods:A retrospective analysis was conducted on 30 patients with varying degrees of skin damage on their limbs who were admitted to the Hand and Foot Surgery Department of Yiwu Central Hospital in Zhejiang Province and Zhejiang Provincial People's Hospital from January 2015 to March 2022. The patients were divided into observation group ( n=15) and control group ( n=15) based on whether CTA three-dimensional reconstruction was performed preoperatively. In the observation group, CTA three-dimensional reconstruction was performed preoperatively, including 9 males and 6 females, aged 17-67 (49.7±4.2) years. In the control group, handheld Doppler ultrasound angiography was performed preoperatively, including 10 males and 5 females, aged 20-69 (50.4±5.0) years. Relevant intraoperative and postoperative indicators were compared between the two groups, including operation duration, anesthesia recovery time, blood loss, perforator localization accuracy, vascular anastomosis rate between the donor and recipient sites, flap harvesting time, flap survival rate, and incidence of adverse reactions. Follow-up visits were conducted via telephone or outpatient clinic for 3 months postoperatively, with one visit per month, to assess patient satisfaction rates. A multi-criteria decision-making model was established, and the benefit values, risk values, and stability of the decision-making model were evaluated for both groups. Results:Compared with the control group, the observation group had significantly reduced operation duration, anesthesia recovery time, blood loss, and flap harvesting time (all P<0.05). The patient satisfaction rate, perforator localization accuracy, and vascular anastomosis rate between the donor and recipient sites were significantly better in the observation group than in the control group (all P<0.05). The incidence of adverse reactions was 13.3% (2/15) in the observation group, which was lower than 53.3% (8/15) in the control group ( P=0.020). Among the benefit indicators, the vascular anastomosis rate between the donor and recipient sites and flap survival rate had the greatest impact on treatment outcomes. Among the risk indicators, venous crisis and flap necrosis had a greater impact. The benefit-risk value was 77 in the observation group and 56 in the control group, with a difference of 21 (95% CI: 14-26) between the two groups. The observation group had higher values than the control group within the range of 0-100% relative risk weight, indicating good stability of the multi-criteria decision-making evaluation model. Conclusion:CTA three-dimensional reconstruction technology can improve the vascular anastomosis rate between the donor and recipient sites and patient satisfaction rates in the repair of limb wounds using free double-leaf anterolateral thigh perforator flaps.

ObjectiveTo review the development history of research on people with disabilities, summarize the patterns, characteristics and deficiencies in this discipline, and make suggestions for discipline development in the future. MethodsThe literature about disability from 1986 to 2018 were searched and retrieved on the CNKI. Valid literature were selected based on the title and abstract. Descriptive analyses were used to analyze the development of research on people with disabilities in China. VOSviewer was used to explore the cooperation among researchers and research hotspots in this field. ResultsA total of 2 267 papers were included. Researches on people with disabilities in China started in 1986 and then experienced rapid development driven by survey data, showing obvious stage characteristics. The foundation of academic cooperation networks has been formed initially, showing the comprehensive development of multiple themes. However, in the new stage, the lack of follow-up support for research infrastructure conditions, as well as the slow innovation of research theories and expansion of research contents may become key factors hindering the further development of the discipline. ConclusionThe research foundation should be consolidated in the future, including broadening cooperation and communication channels, strengthening disability statistics, and promoting cross-disciplinary research. Theoretical research should be strengthened by standardizing research methods and finding internalized theoretical innovation points combining the national conditions. Finally, research content should be enriched, especially by closely combining the current changes in the needs of people with disabilities and strengthening the research on disability prevention and control, health promotion, social integration, and social management of the people with disabilities.

Primary liver cancer is one of the most common malignant tumors in the world, and it is also the main cause of cancer-related death. However, the recurrence rate after surgical resection is still high. These problems have led to the development of more neoadjuvant treatment strategies aimed at improving the prognosis and reducing the recurrence rate. Despite the lack of high-level evidence to guide treatment decisions, recent advances in local and systemic therapies, including radiotherapy and immunotherapy, raise the prospect of new approaches that may improve outcomes in hepatocellular carcinoma patients.

Objective:To explore clinical significance of sinus heart rate turbulence (HRT) phenomenon in aged pa‐tients with stable angina pectoris (SAP) .Methods :A total of 120 aged SAP patients ,who received 24h DCG in our hospital from Jan 2013 to Oct 2015 ,were selected as SAP group .Meanwhile ,another 144 aged patients ,who re‐ceived 24h DCG examination simultaneously and coronary angiography results were normal ,were regarded as nor‐mal control group .According to coronary lesion severity ,SAP group was further divided into single vessel coronary disease group (single vessel group ,n=35) ,double‐vessel coronary disease group (double‐vessel group ,n=48) and multi‐vessel coronary disease group (multi‐vessel group ,n=37) .The 24h DCG ,HRT indexes ,including turbulence onset (TO) and turbulence slope (TS) ,were measured and compared among all groups .Results:Compared with normal control group ,there was significant rise in TO [(0.77 ± 0.37)% vs .(1.26 ± 0.92)% ] and significant reduc‐tion in TS [(5.45 ± 4.02) ms/RR interval vs .(1.53 ± 0.70) ms/RR interval] ,P<0.01 both ;significant rise in ab‐normal rates of TO (19.44% vs .42.50% ) ,TS (15.97% vs .31.67% ) and TO + TS (11.11% vs .30.83% ) in SAP group ,P<0.01 all .Compared with single vessel group ,there was significant rise in TO [(0.66 ± 0.22)% vs .(1.28 ± 1.11)% vs .(1.46 ± 1.20)% ] and significant reduction in TS [ (2.04 ± 0.82) ms/RR interval vs .(1.66 ± 0.38) ms/RR interval vs .(1.29 ± 0.58) ms/RR interval] in double‐vessel group and multi‐vessel group ,and TO of multi‐vessel group was significantly higher than that of double‐vessel group ,TS of multi‐vessel group was significantly low‐er than that of double‐vessel group , P<0.01 all .Conclusion:Sinus heart rate turbulence can be used as risk predic‐tor for aged patients with stable angina pectoris ,which can provide basis for clinical effective treatment and progno‐sis assessment .

Equipment Design ; Humans ; Radiography ; instrumentation ; Technology, Radiologic ; X-Rays