ObjectiveTo observe the clinical efficacy of Tongfu Kuanzhong decoction （TFKZ） in the treatment of constipation-predominant irritable bowel syndrome （IBS-C） with spleen deficiency and Qi stagnation and its effects on anorectal manometry and colonic electrical activity parameters. MethodsSixty-four patients with IBS-C of the spleen deficiency and Qi stagnation type were included as research subjects and were randomized into the observation group （thirty-two cases） and control group （thirty-two cases）. The control group was orally administered mosapride citrate tablets， and the observation group was orally administered TFKZ. Both groups were treated for 4 weeks. The traditional Chinese medicine （TCM） syndrome scores， patient assessment of constipation symptoms （PAC-SYM） score， general anxiety disorder-7 （GAD-7） score， patient health questionnaire-9（PHQ-9）score， anorectal manometry， and colonic electrical activity parameters were observed before and after treatment in the two groups. ResultsThe total points of TCM syndromes were significantly lower in both groups after treatment （P<0.01） and lower in the observation group （P<0.05）. The fecal symptoms， rectal symptoms， abdominal symptoms， and total symptom scores of the patients in both groups were significantly decreased after treatment （P<0.01）， and the rectal symptoms， abdominal symptoms， and total symptom scores of the observation group were lower （P<0.05，P<0.01）. In both groups， the forced anal residual pressure and the initial rectal sensation threshold decreased after treatment （P<0.05，P<0.01）， and forced anal residual pressure in the control group was lower （P<0.01）. After treatment， the GAD-7 and PHQ-9 scores of patients in both groups decreased significantly （P<0.01）， and the GAD-7 score of the observation group was significantly lower （P<0.01）. After treatment， the average wave amplitude at different time points of each lead increased significantly in both groups， compared with that before treatment （P<0.01）. The average wave amplitude of each lead of the ascending colon， descending colon， sigmoid colon， and rectum in the observation group at 5 min before the meal and 10 min after the meal， as well as that of the ascending colon and rectum at 20 min and 30 min after the meal， was higher than that of the control group （P<0.05）. ConclusionTFKZ is effective in the treatment of IBS-C. Its mechanism may be related to the regulation of colonic function by down-regulating the forced anal residual pressure and the initial rectal sensation threshold and up-regulating the amplitude and frequency of intestinal electrical activity in each intestinal segment of the colon.

Objective:To compare the clinical efficacy of different guidelines recommending the dosage of paricalcitol in the treatment of maintenance hemodialysis (MHD) with secondary hyperparathyroidism (SHPT).Methods:The clinical data of 150 patients with MHD combined with SHPT in the First Affiliated Hospital of Xinjiang Medical University from January 2021 to January 2022 were retrospectively analyzed. Among them, 75 patients were treated with the recommended dose of paricalcitol according to European guidelines (European guidelines group), and the starting dose was blood intact parathyroid hormone (iPTH) (ng/L)/80 μg; 75 patients were treated with the recommended dose of paricalcitol according to American guidelines (American guidelines group), and the starting dose was 0.04 μg/kg. The blood calcium, blood phosphorus, creatinine and urea nitrogen before treatment and 1, 3 months after treatment were measured, and the calcium phosphorus product was calculated. The serum alkaline phosphatase (ALP) and iPTH before treatment and 3, 6 months after treatment were measured. The adverse reactions (nausea, vomiting and gastrointestinal discomfort) during the treatment were recorded.Results:There were no statistical difference in the indexes before treatment between two groups ( P>0.05). The blood calcium, blood phosphorus and calcium phosphorus product 1 and 3 months after treatment in American guidelines group were significantly lower than those in European guidelines group, 1 month after treatment: (2.40 ± 0.15) mmol/L vs. (2.53 ± 0.23) mmol/L, (1.70 ± 0.15) mmol/L vs. (2.00 ± 0.30) mmol/L and (4.08 ± 0.42) mmol 2/L 2 vs. (5.06 ± 0.47) mmol 2/L 2, 3 months after treatment: (2.37 ± 0.14) mmol/L vs. (2.50 ± 0.25) mmol/L, (1.65 ± 0.13) mmol/L vs. (1.98 ± 0.27) mmol/L and (3.91 ± 0.40) mmol 2/L 2 vs. (4.95 ± 0.45) mmol 2/L 2, and there were statistical differences ( P<0.01). There were no statistical difference in creatinine and urea nitrogen 1 and 3 months after treatment between two groups ( P>0.05). There was no statistical difference in ALP 3 and 6 months after treatment between two groups ( P>0.05); the iPTH 3 and 6 months after treatment in American guidelines group was significantly lower than that in European guidelines group: (348.20 ± 21.50) ng/L vs. (451.65 ± 28.48) ng/L and (252.64 ± 21.64) ng/L vs. (340.48 ± 19.85) ng/L, and there were statistical differences ( P<0.01). There was no statistical difference in incidence of adverse reactions between two groups ( P>0.05). Conclusions:For patients with MHD combined with SHPT, the recommended dosage of paricalcitol in the American guidelines can significantly improve calcium and phosphorus levels and parathyroid function, without affecting renal function or increasing the incidence of adverse reactions.

ObjectiveSleep-related painful erections （SRPE） is a rare sleep disorder characterized by repeated awakening due to painful interruptions of penile erections during nighttime sleep， and its etiology is currently unclear. The purpose of this study is to explore the impact of potential risk factors on the incidence of SRPE. MethodsInformation was collected through questionnaires administered to patients who presented at the urology department and suffered from SRPE or did not suffer from SRPE. A total of 290 participants completed the study， including 145 controls and 145 cases. Logistic regression analysis was used to assess the impact of age， occupation， sleep initiation time per night， frequency of sexual intercourse per week， psychological status， erectile dysfunction， chronic prostatitis， prostate enlargement， lumbar spine disease， central nervous system disease， hypertension， diabetes and family history on the onset of SRPE. ResultsSingle-factor logistic regression analysis found that a history of chronic prostatitis， intellectual labor occupation， central nervous system disease， late sleep onset， frequency of sexual activity， and anxiety status might be related to the onset of SRPE. After incorporating these factors into a multivariate regression analysis model， it was found that having sexual activity ≥2 times/week （OR 95%CI = 0.326（0.179，0.592） and late sleep onset （after 24：00） （OR 95%CI = 0.494（0.265，0.918）might be protective factors for SRPE， while a history of chronic prostatitis（OR 95%CI = 3.779（2.082，6.859） might be a risk factor for SRPE. However， there was no significant statistical difference in the impact of central nervous system diseases and occupation on multivariate analysis. ConclusionChronic prostatitis and anxiety status may be independent risk factors for SRPE； having sexual activity ≥2 times/week and delaying sleep time appropriately may be independent protective factors.

Objective : To detect the risk factors for bleeding in patients with cirrhosis and esophageal and gastric varices (EGV) and better understand the potentially life-threatening complications． Methods : Retrospectively， and a total of 309 patients with cirrhosis and EGV were enrolled in this study and were divided into the observation group and control based on EGV bleeding or not．Meanwhile，the patients＇epidemiological，clinical，laboratory， and radiological characteristics were collected and analyzed to construct a prediction model．The bootstrap method could be used to validate predictive models and the ROC curves to evaluate its forecasting ability. Results : High- density lipoprotein (HDL) (P＜0. 001，OR = 0. 131，95% CI = 0. 049－0. 350) ，C-reactive protein ( CRP) (P = 0. 010，OR = 2. 657，95% CI = 1. 269－5. 563) ，the width of portal vein (PVW) (P = 0. 050，OR = 1. 156，95% CI = 1. 000 －1. 336) ，the thickness of spleen (P = 0. 035，OR = 1. 492，95% CI = 1. 028 －2. 165) ，Child-Pugh grade B (P = 0. 003 ，OR = 11. 320，95% CI = 2. 232 －57. 407 ) and Child-Pugh grade C ( P = 0. 002 ，OR = 3. 888，95% CI = 1. 659－9. 114) were significantly associated with the occurrence of EGV bleeding．The AUC of the predictive risk model in the modeling group was 0. 802，and the validation group was 0. 836． Conclusion The lower HDL and higher CRP，PVW，the thickness of the spleen，Child-Pugh grade B and C are the risk factors for the occurrence of EGV bleeding.

Objective To investigate the changes of sex hormones,anti-Müllerian hormone(AMH)level and ovarian ultrasound imaging parameters in women of childbearing age,so as to analyze their predictive value for premature ovarian insufficiency(POI)and establish the predictive model.Methods A total of 1 968 women of childbearing age in The First Affiliated Hospital of Xi'an Jiaotong University from 2018 to June 2022 were selected as research subjects.Their sex hormones and AMH levels were detected,and ultrasonographic features of the ovary were detected,including antral follicle count(AFC),ovarian volume,ovarian cortical volume,ovarian medulla volume,the total area,ovarian cortical area,and ovarian medulla area.The changes in ovarian function status at different age were analyzed,and their predictive value for POI was explored.AMH combined with ovarian ultrasound imaging parameters was used to establish a model for predicting POI.Results Among the 1 968 subjects,the prevalence rate of POI was 3.10％.The prevalence rate of POI was significantly higher in 30-39 years old group than in 20-29 years old group(P＜0.05).The serum AMH level in 30-34 years old group was significantly lower than that in 20-24 years old group and 25-29 years old group(P＜0.05),and the serum follicle stimulating hormone(FSH)and luteinizing hormone(LH)levels were significantly higher in 35-39 years old group than in 30-34 years old group(P＜0.05).The serum estradiol(E2)and AMH levels,AFC,ovarian volume,ovarian cortical volume,ovarian area,and ovarian cortical area were significantly lower than those in the 30-34 years old group(P＜0.05).The serum FSH and LH levels in POI group were significantly higher than women of the same age with normal ovarian function(P＜0.05),while the serum E2 and AMH levels were significantly lower than women of the same age with normal ovarian function(P＜0.05).The AFC,ovarian volume,ovarian cortical volume,ovarian medullary volume,ovarian area,ovarian cortical area,and ovarian medullary area in POI group were significantly lower than women of the same age with normal ovarian function(P＜0.05).The analysis results of the predictive value of hormone indicators for POI showed that AMH had the highest predictive value(AUC=0.957),followed by E2(AUC=0.840).Among the ultrasound imaging indicators,AFC had the largest predictive value(AUC=0.867),followed by ovarian cortical volume(AUC=0.835).The model established by AMH combined with ovarian ultrasound imaging parameters had a good predictive value for POI,and its sensitivity was 94.86％,specificity was 91.23％,AUC was 0.960,and the cutoff value was 12 points.Conclusion The prevalence of POI is high in women aged 30-39 years of reproductive age.The model established by AMH combined with ovarian ultrasound imaging parameters has certain predictive value for POI,especially for women in the occult stage,and thus deserves clinical attention.

Objective To evaluate the application effect of joint inventory management method in drug procurement and control management in multiple hospital areas.Methods Based on the joint inventory management model,four pilot drugs were selected from a certain group hospital by reasonable data processing methods for research.The effects of the model application were compared and analyzed from aspects such as inventory cost,turnover situation,and supply situation.Results After applying the joint inventory management model led by the central hospital,the inventory and amount of drugs in the three pilot hospitals were significantly reduced,with the inventory reduced by 31.93%and the average inventory amount decreased by 16.23%;The inventory turnover days had significantly decreased,with the turnover days of all three branches decreasing by more than one day;The drug shortage rate had significantly decreased,with the most significant change among the pilot drugs being the doxorubicin liposome injection,which had a 6.7%decrease in the shortage rate;The comparison results of each group of data showed statistical significance(P＜0.05).Conclusion Adopting a central hospital led joint inventory management model in multiple hospital areas could significantly improve the effectiveness of drug procurement management and inventory management,which enhanced the efficiency of hospital fund utilization.

Background: This study aimed to develop a diabetic kidney disease (DKD) prediction model using long short term memory (LSTM) neural network and evaluate its performance using accuracy, precision, recall, and area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Methods: The study identified DKD risk factors through literature review and physician focus group, and collected 7 years of data from 6,040 type 2 diabetes mellitus patients based on the risk factors. Pytorch was used to build the LSTM neural network, with 70% of the data used for training and the other 30% for testing. Three models were established to examine the impact of glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), and pulse pressure (PP) variabilities on the model’s performance. Results: The developed model achieved an accuracy of 83% and an AUC of 0.83. When the risk factor of HbA1c variability, SBP variability, or PP variability was removed one by one, the accuracy of each model was significantly lower than that of the optimal model, with an accuracy of 78% (P<0.001), 79% (P<0.001), and 81% (P<0.001), respectively. The AUC of ROC was also significantly lower for each model, with values of 0.72 (P<0.001), 0.75 (P<0.001), and 0.77 (P<0.05). Conclusion The developed DKD risk predictive model using LSTM neural networks demonstrated high accuracy and AUC value. When HbA1c, SBP, and PP variabilities were added to the model as featured characteristics, the model’s performance was greatly improved.

Background Under the background of global climate change, temperature has increased dramatically. Most studies about association between temperature and human health are conducted in low-altitude areas, but rarely focus on plateau areas. Objective To examine the association between temperature and non-accidental mortality risk in Tibet Plateau, China and to identify vulnerable populations for formulating targeted policies of climate change adaptation. Methods The mortality data, meteorological data, and pollutant data of Tibet area between 2013 to 2019 were collected. Based on time-stratified case-crossover design, conditional logistic regression models were used to analyze the exposure-response relationship between temperature and cause-specific mortality, which was linearized to obtain excess risk for 1 ℃ change; attributable fraction was calculated for assessing burden attributable to temperature; and stratified analyses were further conducted by gender, age (＜65 years old, ≥65 years old), and causes of death (cardiovascular diseases, cerebrovascular diseases, and respiratory diseases). Sensitivity analyses were conducted by adjusting model parameters and variables. Results A total of 26 045 non-accidental deaths were collected in Tibet during 2013 and 2019, and the P₅₀ of temperature was 5.0 ℃. The non-accidental mortality risk increased as temperature become colder. A 1 ℃ decrease in temperature was associated with a 2.01% (95%CI: 0.94%-3.07%) increase in total non-accidental mortality, while the association changed to 2.05% (95%CI: 0.62%-3.47%) for male and 1.96% (95%CI: 0.34%-3.56%) for female, both of statistial significance; 1.45% (95%CI: −0.10%-2.98%) for the people <65 years old (not of significance) and 2.52% (95% CI : 1.04%-3.99%) for the people ≥65 years old (of significance); the excess risk for cardiovascular mortality was 2.65% (95%CI: 1.03%-4.24%), for cerebrovascular mortality was 3.70% (95%CI: 0.74%-6.57%), both of statistical significance, and for respiratory mortality was 2.18% (95%CI: −0.14%-4.44%), without significance. The total attribution number of non-accidental mortality was 5340 (95%CI: 2719-7528), and the total attributable fraction was 20.50% (95%CI: 10.44%-28.91%). The attributable fractions were higher in specific subgroups like male (20.72%), people ≥65 years (23.33%), and people with cardiovascular diseases (26.07%). Conclusion The exposure-response relationship between temperature and non-accidental mortality in Tibet showes that the non-accidental mortality risk increase as temperature become colder. The attributable burden of disease is heavy. Residents being male, ≥65 years, with cardiovascular diseases and respiratory diseases may be vulnerable to nonoptimal temperature.

Pharmacy active consultation refers to the spontaneous activity that clinical pharmacists take the initiative to go to clinical departments to help doctors solve problems related to drug use in clinical practice ，put forward drug treatment suggestions or provide pharmaceutical services ，and form medical documents . The difference between pharmacy active consultation and pharmacy consultation is that the latter is generally proposed by the clinician ，who sends a consultation invitation to the pharmacy department in the hospital information system ，and the clinical pharmacist will go to the consultation after receiving it ，while the former is a pharmaceutical service mode that the clinical pharmacist takes the initiative to carry out in the clinical department . On the basis of routine pharmacy active consultation ，clinical pharmacists in our hospital also further carried out a special active consultation mode （including prompt special active consultation for patients with multidrug resistance bacteria positive ，active monitoring and intervention for patients with drug -induced liver injury ），and patient pharmaceutical supervision in the form of return visit of pharmacy active consultation . Pharmacy active consultation and its special active consultation possess the characteristics of initiative ， early and extensive coverage ，as a supplement to resident clinical pharmacy services . Pharmacy active consultation could help the pharmacy department to improve service efficiency ，provide a new perspective for medical institutions to carry out efficient pharmaceutical services ，and supply new ideas for the reform of pharmaceutical services in China .

Objective:To investigate the correlation of intratumoral fibrosis with the prognosis of clear cell renal cell carcinoma (ccRCC).Methods:The correlation of the transcriptional expression of the primary collagen with the prognosis in ccRCC was evaluated using the Cancer Genome Atlas (TCGA) database, including 530 ccRCC patients with complete information. Of them, 344 cases were male, 186 cases were female. The age of 264 cases was ≤ 60 years, and the age of 266 cases was > 60 years. The pathology grade of 241 patients was G 1-2 grade, and the pathology of 281 cases were G 3-4 grade, 8 cases were undetermined grade. There were 322 cases with AJCC stage Ⅰ-Ⅱ and 205 cases with AJCC stage Ⅲ-Ⅳ, and 3 cases with undetermined stage. There were 420 cases in M 0 and 78 cases in M 1, and 32 cases without distant metastases information. Furthermore, the paraffin sections of 158 non-cystic ccRCC patients confirmed by pathology from November 2005 to November 2017 were further used to evaluate the level of collagen of ccRCC and the status of the pseudocapsule by the Masson staining, Sirius red staining and multicolor immunofluorescence staining of collagen Ⅰ and collagen Ⅲ. Of them, 112 cases were male, 46 cases were female. There were 100 cases with age ≤ 60 years, and 58 cases with age > 60 years. The pathology grade of 111 cases were G 1-2, and the pathology grade of 47 cases were G 3-4. There were 144 cases with AJCC stage Ⅰ-Ⅱ, 14 cases with AJCC stage Ⅲ-Ⅳ. Kaplan-Meier survival curve were used to analyze the relationship between tumor collagen parameters and the overall survival prognosis of patients with ccRCC. Results:The transcriptome results of the TCGA database indicated that the expression level of COL1A1 in ccRCC tissues was significantly higher than that in adjacent normal tissues ( P<0.001). The high expression of collagen suggested a worse overall survival prognosis ( HR=1.165, P=0.002). In addition, the high ratio of COL1A1/COL3A1 indicated a worse overall survival prognosis ( HR=1.901, P<0.001) compared with the low ratio. We further confirmed that the abundance of collagen in tumor was significantly increased compared with the normal adjacent tissues by the Masson staining [41.0 (14.0-75.0) vs.15.0 (3.0-57.0), P<0.001] and the Sirius red staining [42.5 (10.0-90.0) vs.10.0 (2.5-60.0), P<0.001] on 30 ccRCC tissues and adjacent normal tissues. Based on the Masson staining, we found that high collagen abundance in tumor tissue was associated with more G 3-4 grade of tumor compared with low collagen abundance (38.5% vs.21.3%, OR=2.316, 95% CI 1.146-4.681, P=0.023). Kaplan-Meier survival curve showed that higher collagen abundance was associated with a worse overall survival prognosis in ccRCC ( HR=2.630, P=0.007). However, incomplete fibrous pseudocapsule was associated with a worse overall survival prognosis ( HR=11.140, P<0.001). Conclusions:In ccRCC, intratumoral collagen fiber level was overexpressed. High intratumoral collagen level and incomplete fibrous pseudocapsule may indicate a poor overall survival prognosis.