OBJECTIVE To explore a model for constructing a platform for medical institution formulation and provide insights for promoting their development. METHODS By systematically reviewing the development status and challenges of medical institution preparations in China， and based on the theory of industry-university-research collaborative innovation， the organizational structure， collaborative processes， and safeguard mechanisms of the platform were designed. RESULTS & CONCLUSIONS Medical institution formulations in China mainly faced challenges such as weak research and development （R&D） capacity， uneven quality standards， and blocked transformation pathways. This study established a full-chain， whole- industry collaborative innovation network covering the government， medical institutions， universities/research institutes， pharmaceutical enterprises， and the market， forming a new “government-industry-university-research-application” five-in-one platform model for medical institution formulations. By establishing mechanisms such as multi-entity collaborative cooperation， full- chain intellectual property management， contribution-based benefit distribution， staged risk-sharing， and third-party evaluation， the model clarified the responsibilities and collaborative pathways of all parties. The new model highlights the whole-process transformation of clinical experience-based prescriptions， enabling precise alignment between clinical needs and technological R&D， as well as between preparation achievements and industrial transformation. While breaking down the barriers of traditional platform construction， it effectively achieves optimal resource allocation and complementary advantages， addresses problems emerging in the development of medical institution preparations， and provides reference value for the formulation of relevant systems.

ObjectiveTo analyze the expression level of triggering receptor expressed on myeloid cells-1 （TREM-1） in serum and ascites of patients with cirrhotic ascites， and to investigate its correlation with clinical features and inflammatory markers and its role in the diagnosis of infection and prognostic evaluation. MethodsA total of 110 patients with cirrhotic ascites who were hospitalized in The Fifth Hospital of Shijiazhuang from January 2019 to December 2020 were enrolled， and according to the presence or absence of intra-abdominal infection， they were divided into infection group with 72 patients and non-infection group with 38 patients. The patients with infection were further divided into improvement group with 38 patients and non-improvement group with 34 patients. Clinical data and laboratory markers were collected from all patients. Serum and ascites samples were collected， and ELISA was used to measure the level of TREM-1. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups； the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate the correlation between indicators. A multivariate Logistic regression analysis was used to identify the influencing factors for the prognosis of patients with cirrhotic ascites and infection. The receiver operating characteristic （ROC） curve was used to evaluate the diagnostic and prognostic efficacy of each indicator， and the Delong test was used for comparison of the area under the ROC curve （AUC）. ResultsThe level of TREM-1 in ascites was significantly positively correlated with that in serum （r=0.50， P<0.001）. Compared with the improvement group， the non-improvement group had a significantly higher level of TREM-1 in ascites （Z=-2.391， P=0.017） and serum （Z=-2.544， P=0.011）， and compared with the non-infection group， the infection group had a significantly higher level of TREM-1 in ascites （Z=-3.420， P<0.001）， while there was no significant difference in the level of TREM-1 in serum between the two groups （P>0.05）. The level of TREM-1 in serum and ascites were significantly positively correlated with C-reactive protein （CRP）， procalcitonin （PCT）， white blood cell count， and neutrophil-lymphocyte ratio （r=0.288， 0.344， 0.530， 0.510， 0.534， 0.454， 0.330， and 0.404， all P<0.05）. The ROC curve analysis showed that when PCT， CRP， and serum or ascitic TREM-1 were used in combination for the diagnosis of cirrhotic ascites with infection， the AUCs were 0.715 and 0.740， respectively. The multivariate Logistic regression analysis showed that CRP （odds ratio ［OR］=1.019， 95% confidence interval ［CI］： 1.001‍ ‍—‍ ‍1.038， P=0.043） and serum TREM-1 （OR=1.002， 95%CI： 1.000‍ ‍—‍ ‍1.003， P=0.016） were independent risk factors for the prognosis of patients with cirrhotic ascites and infection， and the combination of these two indicators had an AUC of 0.728 in predicting poor prognosis. ConclusionThe level of TREM-1 is closely associated with the severity of infection and prognosis in patients with cirrhotic ascites， and combined measurement of TREM-1 and CRP/PCT can improve the diagnostic accuracy of infection and provide support for prognostic evaluation.

Objective To investigate the inhibitory effect of erianin on T cell proliferation and its underlying mechanism.Methods Peripheral blood mononuclear cells(PBMCs)were isolated using density gradient centrifugation,and T cells were purified by magnetic-activated cell sorting(MACS)with immunomagnetic beads,followed by being activated with anti-human CD3 antibodies and anti-human CD28 antibodies.The activated T cells were labeled with carboxyfluorescein succinimidyl ester(CFSE),and the effects of erianin(0.05～0.20 μmol/L)on the proliferation,apoptosis,expression of activation marker cluster of differentiation 25(CD25),cell cycle distribution of activated T cells,as well as the survival rate of resting T cells were assessed using flow cytometry.Enzyme-linked immunosorbent assay(ELISA)was applied to determine the secretion levels of IL-2 and IL-17 in the culture supernatant of erianin-treated activated T cells.Western blotting was employed to examine the impact of erianin on the protein expression of cell division cycle protein 2(CDC2),phosphorylated CDC2(p-CDC2),and Cyclin B1.The differences were observed between the erianin-treated group and the positive control group(activation with CD3/CD28 antibodies).Results CFSE proliferation assay demonstrated that the proliferative rate of activated T cells was in a concentration-dependent decline after 0.05～0.20 μmol/L erianin treatment(P<0.0001),with a half-maximal inhibitory concentration(IC50)of 0.09±0.10 μmol/L.No significant differences were observed in apoptotic rates or survival rates among the erianin-treated groups(activated and resting T cells)and the positive control cells.Analysis of T cell activation markers revealed that erianin had no impact on CD25 expression or IL-2 secretion.However,ELISA results indicated erianin exerted a significant suppression on the secretion of pro-inflammatory cytokine IL-17(P<0.0001).Cell cycle analysis showed that erianin arrested activated T cells at the G2/M phase(P<0.05).Further mechanistic investigations demonstrated that while erianin did not alter CDC2 phosphorylation or total CDC2 expression,but it markedly down-regulated CyclinB1 expression(P<0.01).Conclusion Erianin exhibits potent immunomodulatory activity by suppressing activated T cell proliferation through down-regulating Cyclin B1.

Objective To develop and validate a risk prediction model for infiltration/extravasation in peripheral intravenous catheter therapy.Methods This retrospective study analyzed 942 patients who completed the Infiltration/Extravasation Risk Assessment Form between January and June 2023 at the First Affiliated Hospital of Army Medical University(including Departments of Neurology,Endocrinology,Gastroenterology and Hepatobiliary Surgery).Patients were allocated to a derivation cohort(n=628)and validation cohort(n=314)in a 2∶1 ratio based on catheterization chronology.The derivation cohort served for model development and internal validation,while the validation cohort underwent external validation.Logistic scoring method constructed the risk model,with Hosmer-Lemeshow(HL)test assessing goodness-of-fit and ROC curve evaluating predictive performance.Twenty-one potential risk factors were assessed,including age,gender,chronic diseases,clinician experience,treatment compliance,and total infusion volume.Results Infiltration/extravasation occurred in 48 cases(5.10%incidence:31 derivation/17 validation).Among 21 factors,15 showed significant association(P<0.05),with 6 independent predictors:junior high school education or below(OR=5.2),chronic disease history(OR=3.1),poor compliance(OR=2.8),lower extremity venipuncture(OR=4.1),total infusion≥1 000 mL(OR=3.5),and hyperosmotic/corrosive medications(OR=6.7).The final prediction model was:Y=2×(low education)+1×(chronic disease)+1×(poor compliance)+1×(lower extremity puncture)+1×(volume≥1 000 mL)+2×(corrosive agents).For the derivation cohort,AUC was 0.967(95%CI:0.936～0.998),specificity 0.911,sensitivity 0.935,with good calibration(χ2=4.135,P=0.845).Validation cohort showed AUC 0.939(0.853～1.000),specificity 0.919,sensitivity 0.941,and acceptable calibration(χ2=8.998,P=0.085).Conclusion This model demonstrates excellent discriminative ability and calibration,providing an effective tool for identifying high-risk patients and guiding targeted preventive strategies.

Humans ; Histamine ; Receptors, Histamine H2 ; Schizophrenia/drug therapy*

OBJECTIVE To clarify the institutional logics of the dilemma of the use of national medical insurance negotiation drugs（referred to as “national negotiation drugs”）， and promote the implementation and use of these drugs in medical institutions. METHODS Based on the complex institutional environment in which medical institutions were situated， the theory of multiple institutional logics was used to construct an analytical framework for the behavioral choices of medical institutions， and reveal the mechanism of the difficulty in the use of national negotiation drugs by clarifying the interaction and conflict of multiple logics in this process， so as to put forward some measures. RESULTS & CONCLUSIONS There were contradictions and coupling among the state logic， market logic， social logic and professional logic in the use of national negotiation drugs. In the game of multiple logics， the market logic and professional logic tended to be risk-averse， the failed “pressure-type system” of state logic， and the social logic was weakened， which caused the lack of action in the use of national negotiation drugs with the goal of completing performance evaluations in the current medical institutions. Thus， it is suggested to unbundle the invisible policy restrictions on the use of national negotiation drugs， form the pressure and motivation of medical institutions by incentive and constraint mechanisms， respond to the clinical demand by establishing a green procurement channel， and construct the supervision mechanism on the use of national negotiation drugs by social force， etc.， so as to enhance the effect of the national negotiation drugs.

Objective To investigate the role of lncSIL in transforming growth factor-β1(TGF-β1)-induced alveo-lar epithelial interstitial transformation(EMT)and its related signaling pathways.Methods Western blot was used to detect the effect of lncSIL silencing on the expression of E-cadherin(E-cad),alpha-smooth muscle actin(α-SMA)and Collagen I(Col I)in the process of EMT induced by TGF-β1.LncSIL interacting proteins were ana-lyzed by RNA pulldown.Western blot was used to detect the effect of overexpression or silencing of lncSIL on the expression of its target gene enhancer of zeste homolog 2(EZH2)and its downstream factors P21 and cyclin-de-pendent kinase 6(CDK6).Flow cytometry was used to analyze the effect of lncSIL on cell cycle progression.Re-sults After lncSIL silencing,the expression of α-SMA and Col I increased,the expression of E-cad decreased.RNA pulldown assay showed that EZH2 was the target protein that interacted with lncSIL,and the expression of EZH2 increased after silencing lncSIL,the expression of EZH2 downstream gene P21 decreased,CDK6 increased.Flow cytometry showed that the number of cells in S phase significantly increased.When lncSIL was overexpressed,the expression of EZH2 and CDK6 was down-regulated,the expression of P21 was up-regulated,and the number of S phase cells significantly decreased.Conclusion LncSIL inhibits TGF-β1-induced alveolar epithelial cell mesen-chymal transition by negatively regulating EZH2/P21/CDK6 signaling pathway to inhibit cell cycle progression.

Objective:To evaluate the impact of self-crosslinked hyaluronic acid (SCH) gel on endometrium recovery after artificial abortion.Methods:A multicenter, prospective randomized controlled trial was conducted across 18 hospitals from December 2021 to February 2023, involving 382 women who underwent artificial abortion. Participants were randomly allocated to receive either treatment with SCH gel (SCH group) or no treatment (control group) in a 1∶1 ratio. The primary outcome was endometrium thickness in 14 to 18 days after the first postoperative menstruation. Secondary outcomes included changes in menstrual volume during the first postoperative menstruation, menstruation resumption within 6 postoperative weeks, time to menstruation resumption, duration of the first postoperative menstruation, and incidence of dysmenorrhea.Results:Baseline characteristics of participants were comparable between the two groups (all P>0.05), with 95.3% (182/191) in SCH group and 92.7% (177/191) in the control group completed the study. The postoperative endometrial thickness in SCH group was significantly greater than that in the control group [(9.78±3.15) vs (8.95±2.32) mm; P=0.005]. SCH group also had significantly fewer participants with reduced menstrual volume [23 cases (12.6%, 23/182) vs 31 cases (17.5%, 31/177); P=0.038]. Although SCH group experienced less dysmenorrhea during the first postoperative menstrual period, this difference was not statistically significant [28.5% (51/179) vs 37.1% (65/175); P=0.083]. Outcomes were similar between SCH group and the control group regarding the proportion of participants who resumed menstruation within 6 weeks postoperatively, time to menstruation resumption, and duration of the first postoperative menstruation ( P=0.792, 0.485, and 0.254, respectively). No serious adverse events were observed during the study period, and no adverse events were attributed to SCH gel treatment. Conclusion:The application of SCH gel after artificial abortion is safe and might aid in the recovery of the endometrium.

Objective To explore the clinical efficacy of Fuling Zexie Decoction combined with lifestyle intervention in patients with metabolic syndrome (MetS) of dampness syndrome. Methods A total of 40 patients with MetS of dampness syndrome were randomly divided into experimental group (n=20) and control group (n=20) according to a randomized double-blind placebo-controlled design. The experimental group was given oral administration of Fuling Zexie Decoction,the control group was given placebo,150 mL each time,twice a day. Both groups were given healthy lifestyle(healthy eating habits and exercise mode) education. The intervention period was 16 weeks. Traditional Chinese medicine dampness syndrome scale score and the diagnostic indexes of MetS,including waist circumference (WC),systolic blood pressure (SBP),diastolic blood pressure (DBP),triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and fasting blood glucose (FBG),were evaluated before and after treatment. Other metabolic indexes such as body mass index(BMI),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),uric acid(UC),as well as inflammation related indexes including C-reactive protein (CRP),interleukin-6 (IL-6) and tumor necrosis factor(TNF-α) were also evaluated. Results A total of 33 people completed the trial,including 17 people in the experimental group and 16 people in the control group. Compared to the baseline period,FBG,BMI,LDL-C and dampness syndrome scale score in the experimental group were significantly decreased at the 8th and 16th week of intervention(P<0.05). WC was significantly decreased at the 8th week of intervention(P<0.05). CRP showed a downward trend at the 16th week of intervention(P<0.05). Moreover,SBP and IL-6 in control group decreased significantly at the 8th and 16th week of intervention(P<0.05). WC,DBP and HOMA-IR decreased significantly at the 8th week of intervention (P<0.05). There was no significant difference in other outcome indexes between the two groups at the 8th and 16th week of intervention (P>0.05). The safety indexes of all patients before and after intervention were not significantly abnormal,and no serious adverse events occurred. Conclusion This study initially shows the positive regulatory effect of Fuling Zexie Decoction combined with lifestyle on metabolism and inflammation-related indexes in people with MetS of dampness syndrome,which helps to improve the level of dampness syndrome and provides a basis for further research.

Objective:To evaluate the residual risk (RR) of transfusion transmitted HIV (TT-HIV) after the implementation of nucleic acid amplification test (NAT) in blood screening test among blood centers in China.Methods:The data of blood donors and HIV infection markers from 2017 to 2020 were collected from 28 blood centers via the Platform of Comparison of blood establishments Practice in Chinese Mainland. The new infection rate/window period mathematical model was used for two types of blood screening strategies, namely, two rounds ELISA plus individual NAT take turn with pooling NAT (2ELISA+ ID-NAT/MP-NAT) and two ELISA plus one round pooling NAT (2ELISA+ MP-NAT), and the RR of HIV infection was estimated also based on first donors (FDs) and repeated donors (RDs) in different blood donation years. T-test analyses were conducted for comparing TT HIV RR among FDs and RDs in different blood donation years with two blood screening strategies, and the variation trend of RR in HIV test was observed.Results:From 2017 to 2020, the RR of FDs in 2ELISA+ ID-NAT/MP-NAT blood screening strategy was 2.869/10 6 person-year, 3.795/10 6 persons-year, 3.879/10 6 person-year, and 2.890/10 6 person-year respectively. The RR of RDs was 1.797/10 6 person-year, 1.502/10 6 person-year, 1.857/10 6 person-year, and 1.483/10 6 person-year respectively. Significant difference exists between RR of FDs and RDs, with F=9.898 and p<0.05. In 2ELISA+ MP-NAT strategy, the RR of FDs was 3.508/10 6 person-year, 1.868/10 6 person-year, 2.204/10 6 person-year, and 1.765/10 6 person-year respectively. The RR of RDs was 0.948/10 6 person-year, 0.926/10 6 person-year, 0.748/10 6 person-year, and 0.682/10 6 person-year respectively. Statistical difference existed between RR of FDs and RDs, with F=17.126 and P<0.05. There was no significant difference between the RR of FDs in these two strategies with F=3.493 and P>0.05, while there was a difference between the RR of RDs in these two strategies with F=24.516 and P<0.05, and a difference between the RR of total donors (TDs) in these two strategies F=20.216 and P<0.05. Conclusions:The RR of TT HIV significantly decreased after the introduction of NAT into blood test among blood centers in China. There were some differences in the RR of HIV testing among different blood screening strategies. There could be significant differences in the RR of HIV testing among different groups of blood donors. Compared with FDs, RDs is the low risk group for HIV.