Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

OBJECTIVE To analyze the occurrence characteristics and risk factors of adverse drug reactions （ADR） of gemcitabine for injection in national centralized volume-based procurement （hereinafter referred to as “centralized procurement”）， and provide reference for clinical safe drug use. METHODS A retrospective study was conducted to collect the relevant case reports of gemcitabine for injection reported to the National Adverse Drug Reaction Monitoring System by Inner Mongolia Autonomous Region from January 2022 to December 2023； basic information of patients， drug use status， patient outcomes， rational drug use and other information were collected， and the occurrence characteristics of ADRs with leukopenia， myelosuppression， neutropenia， thrombocytopenia and liver dysfunction were analyzed. Univariate analysis and multivariate Logistic regression were used to analyze the correlation of gender， age， combination of antitumor drugs， original malignant tumor and drug dose with ADR. RESULTS A total of 315 cases reports （315 patients） of gemcitabine-induced ADR were included in this study， with a male-to-female ratio of 1.42∶1 and age of （61.17±9.13） years. The primary malignant tumor was pancreatic cancer （73 cases， 23.17%）. Leukopenia， myelosuppression and nausea were the most common ADR， followed by neutropenia， thrombocytopenia， liver dysfunction and so on. The severity grade of ADR was mainly 1-2， and the outcome of most ADR was good. Multivariate Logistic regression analysis showed that combination of antitumor drugs was a risk factor for myelosuppression and neutropenia （RR＝2.154， 95%CI： 1.218- 3.807， P＝0.008； RR＝3.099， 95%CI： 1.240-7.744， P＝0.016）； gender （female） was a risk factor for leukopenia and liver dysfunction （RR＝0.508， 95%CI： 0.302-0.853， P＝0.010； RR＝0.301， 95%CI： 0.102-0.887， P＝0.029）. In terms of drug use rationality， there were 143 cases （45.40%） of drug 126.com use in accordance with the indications of the label， and 172 cases （54.60%） of off-label drug use. Among them， the primary malignant tumors were bladder cancer， bile duct cancer and ovarian cancer， which ranked the top three off-label drug use. CONCLUSIONS The ADR caused by gemcitabine in Inner Mongolia is mainly in the blood and digestive systems. The severity of ADRs is mainly classified as 1-2 levels， and most ADRs have good outcomes. Gender （female） and combination medication are risk factors for gemcitabine-induced ADR. Appropriate chemotherapy regimen should be selected according to the patient’s condition and physical condition， and ADR monitoring in blood and digestive systems should be strengthened during medication of gemcitabine.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Objective To construct a key technical indicator system for in-hospital treatment and nursing of patients with nuclear radiation injury, and provide a basis for the implementation of such treatment and nursing. Methods The draft of the key technical indicator system for in-hospital treatment and nursing of patients with nuclear radiation injury was determined by literature review, case study, and field investigation. The indicators of the system were determined through two rounds of Delphi consultation and using the precedence chart method. According to the criteria of indicator evaluation, the reliability of expert opinions, and the opinions of the research group, the indicators were refined and evaluated. Results Twenty experts were included for two rounds of consultation via mailed inquiries, with a 100% effective response rate in both rounds. The expert authority coefficients were both 0.945, and the Kendall’s W values were 0.347 and 0.448, respectively (P < 0.05). Following the expert consultations, 1 indicator was deleted, 12 indicators were added, and 6 indicators were modified. The key technical indicator system for in-hospital treatment and nursing of patients with nuclear radiation injury established in this study included 4 first-level indicators, 17 second-level indicators, and 73 third-level indicators. The means of importance assignment for all indicators were > 4.00, and the coefficients of variation were < 0.25. Conclusion The key technical indicator system for in-hospital treatment and nursing of patients with nuclear radiation injury established in this study is scientifically rigorous and practically grounded. The indicators demonstrate strong professional relevance and provide important guidance for in-hospital treatment and nursing of patients with nuclear radiation injury.

Objective:This study targets students enrolled in the Sino-foreign joint clinical medicine program collaboratively run by Chongqing Medical University, China and the University of Leicester, UK, aiming to propose suggestions and improvement measures on optimizing students' learning experiences and promoting the high-quality development of Sino-foreign cooperative education through questionnaire survey analysis.Methods:This study utilized convenience sampling and a self-designed questionnaire to collect feedback on the curriculum system and teaching methods, the adaptability of the educational system to the Chinese clinical practitioner examination, and the approaches and benefits of studying abroad. The data were presented as percentages.Results:Among the 75 respondents, 32 (42.67%) students expressed overall satisfaction or high satisfaction with the curriculum system and teaching methods. Specifically, 22 (29.33%) students were satisfied or very satisfied with the teaching methods of the Sino-foreign joint medical courses. Regarding the educational system's adaptability to the Chinese clinical practitioner examination, 74 (98.67%) students felt that the medical education provided by the joint program needed further adjustments or improvements, of whom 53 (70.67%) students believed that the content of the joint program was somewhat or not well aligned with the requirements of the Chinese practitioner examination, and 55 (73.33%) students thought that the joint program's discipline structure was not sufficiently comprehensive for training medical professionals. In terms of studying abroad, 57 (76.00%) students felt that overseas study had a positive impact on enhancing their overall quality.Conclusions:The joint clinical medicine program at our university draws on British educational principles to improve overall student quality. In response to students' needs regarding the curriculum system, teaching methods, and practitioner examination, the university plans to refine its teaching content and methods by implementing innovative training concepts, focusing on interdisciplinary integration, streamlining the curriculum, increasing tutoring, and promoting case-based group discussions to improve classroom teaching quality.

Objective:To explore the real experience of parturients with pernicious placenta previa and placenta increta undergoing cesarean section from diagnosis to childbirth, so as to provide theoretical basis for clinical treatment and nursing decision-making.Methods:This study was a qualitative study. From November 2022 to January 2023, purposive sampling was used to select 13 parturients with pernicious placenta previa and placenta increta in the Department of Obstetrics of the First Affiliated Hospital of Zhengzhou University for semi-structured in-depth interviews. After collecting and organizing interview data, the Colaizzi 7-step analysis method was used to analyze the data, in order to understand the real experiences of parturients with pernicious placenta previa and placenta increta undergoing cesarean section.Results:The real experience of parturients with pernicious placenta previa and placenta increta undergoing cesarean section was extracted into three themes and 12 sub-themes. The first theme was the difficulties in seeking medical advice, with a complex and tortuous inner experience (the sub-themes include the unknown and fear in the early stages of diagnosis, the difficult struggle to make medical decisions, the arduous journey to protect the fetus, the physical and mental pain during the perioperative period, the joy of being born in a desperate situation, and concerns about the newborn and the new family pattern). The second theme was the personal positive coping experience during pregnancy and childbirth (the sub-themes include actively seeking disease information and professional support, quickly changing roles and completing role adaptation, evoking past experiences and reflecting resilient multipara traits). The third theme was to effectively utilize family social support (the sub-themes include trust and compliance with medical institutions to meet disease diagnosis and treatment needs, receiving professional guidance from medical and nursing staff to eliminate negative psychology and meet knowledge needs, benefiting from spouse and family support to meet life and emotional needs) .Conclusions:Parturients with pernicious placenta previa and placenta increta undergoing cesarean section can actively cope with the disease during pregnancy and childbirth, but still have negative emotions. Medical and nursing staff should promptly anticipate potential risks, provide correct information, professional guidance, and assistance to pregnant and postpartum women and their families, and eliminate their negative psychology among them.

This study aims to establish a multiplex TaqMan fluorescence quantitative PCR(qPCR)assay for Pasteurella multocida(P.multocida).Specific primers and fluorescent labeling probes were designed based on the sequences of five podoplanar genes of P.multocida hyaC-hyaD,bcbD,dcbF,ecbJ,and fcbD in the NCBI database.We adjusted the annealing temperature by gradient setting,optimized the primer and probe concentrations by matrix method,constructed standard curves,and performed specificity,sensitivity and reproducibility tests,and finally established mul-tiplexed TaqMan qPCR assays for these five genes.The results showed that the established assay had a good linear relationship between the amplification curves.The sensitivity of this method was high,10-100 times higher than that of ordinary PCR;the specificity was strong,and there was no amplification curve in the DNA detection of eight pathogenic bacteria such as Bacillus,Proteus mirabilis,Staphylococcus aureus,and Rhizoctonia rad iodurans.This assay had a good linear rela-tionship,and the coefficients of variation for Ct values of the inter-and intra-group reproducibility tests were all less than 3％,and the detection rate of this assay was 11.25％higher than the con-ventional PCR assay through the detection of 90 clinical samples.The method established in this study is able to detect P.multocida rapidly and sensitively,which is important for its rapid clinical and laboratory diagnosis.

Intestinal dysbiosis and disrupted bile acid(BA)homeostasis are associated with obesity,but the precise mechanisms remain insufficiently explored.Hepatic protein phosphatase 1 regulatory subunit 3G(PPP1R3G)plays a pivotal role in regulating glycolipid metabolism;nevertheless,its obesity-combatting potency remains unclear.In this study,a substantial reduction was observed in serum PPP1R3G levels in high-body mass index(BMI)and high-fat diet(HFD)-exposed mice,establishing a positive correlation between PPP1R3G and non-12α-hydroxylated(non-12-OH)BA content.Additionally,hepatocyte-specific overexpression of Ppp1r3g(PPP1R3G HOE)mitigated HFD-induced obesity as evidenced by reduced weight,fat mass,and an improved serum lipid profile;hepatic steatosis alleviation was confirmed by normalized liver enzymes and histology.PPP1R3G HOE considerably impacted systemic BA homeostasis,which notably increased the non-12-OH BAs ratio,particularly lithocholic acid(LCA).16S ribosomal DNA(16S rDNA)sequencing assay indicated that PPP1R3G HOE reversed HFD-induced gut dysbiosis by reducing the Firmicutes/Bacteroidetes ratio and Lactobacillus population,and elevating the relative abundance of Blautia,which exhibited a positive correlation with serum LCA levels.A fecal microbiome transplantation test confirmed that the anti-obesity effect of hepatic PPP1R3G was gut microbiota-dependent.Mechanistically,PPP1R3G HOE markedly suppressed hepatic cholesterol 7α-hydroxylase(CYP7A1)and sterol-12α-hydroxylase(CYP8B1),and concurrently upregulated oxysterol 7-α hydroxylase and Takeda G protein-coupled BA receptor 5(TGR5)expression under HFD conditions.Furthermore,LCA administration significantly mitigated the HFD-induced obesity phenotype and elevated non-12-OH BA levels.These findings emphasize the significance of hepatic PPP1R3G in ameliorating diet-induced adiposity and hepatic steatosis through the gut microbiota-BA axis,which may serve as potential ther-apeutic targets for obesity-related disorders.

Objective:To construct a prediction model for ventilator-associated pneumonia (VAP) in mechanically ventilated preterm infants in the neonatal intensive care unit (NICU) and to test its clinical effect.Methods:This was a cross-sectional study. A total of 740 preterm infants admitted to the NICU for mechanical ventilation from July 2018 to June 2023 were retrospectively selected as the study subjects, and were divided into the modeling set (518 cases) and the validation set (222 cases) according to the ratio of 7∶3 using the computer-generated random number method. The modeling set was divided into the VAP group (181 cases) and the non-VAP group (337 cases) according to whether VAP occured, and 21 clinical characteristics were analyzed, using single factor difference analysis to screen predictive factors, the independent risk factors of VAP in mechanically ventilated preterm infants were determined by multivariate Logistic regression analysis, and the nomogram model was made by R software. Then, the nomogram model was tested by validating the data of the validation set. The receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test, calibration curve and clinical decision curve were used to evaluate the efficacy and practical value of the model.Results:There were 88 males and 93 females in the VAP group, with 156 cases of gestational age<34 weeks and 25 cases of gestational age≥34 weeks. There were 155 males and 182 females in the non-VAP group, with 196 cases of gestational age<34 weeks and 141 cases of gestational age≥34 weeks. Birth weight ( OR=0.114, 95% CI 0.044-0.268, P<0.05) and oral care of breast milk ( OR=0.124, 95% CI 0.0.057-0.249, P<0.05) were protective factors for VAP in mechanically ventilated preterm infants, and Apgar score at 5 min after birth ( OR=2.895, 95% CI 1.318-6.419, P<0.05), serum prealbumin at 72 h of mechanical ventilation ( OR=4.837, 95% CI 2.643-9.063, P<0.05), gastric contents reflux ( OR=6.754, 95% CI 3.156-15.240, P<0.05), and time of mechanical ventilation ( OR=7.784, 95% CI 3.491-18.160, P<0.05) were independent risk factors for VAP in mechanically ventilated preterm infants. The area under the curve (AUC) of the ROC curve of the modeling set was 0.929 (95% CI 0.907-0.950, P<0.01), and the validation set (AUC) was 0.917 (95% CI 0.882-0.952, P<0.01), the model has good discrimination. The C indices of the modeling set and the validation set were 0.93 and 0.92 respectively by sampling 500 times by the Bootstrap method, indicating that the model had good consistency, and the decision curve suggested that the prediction model was far from the extreme curve and the net return value was high, indicating that the nomogram prediction model constructed this time had high prediction value. Conclusions:Birth weight, Apgar score at 5 min after birth, time of mechanical ventilation, oral care of breast milk, serum prealbumin at 72 h of mechanical ventilation, and gastric contents reflux are independent influencing factors for VAP in mechanically ventilated preterm infants. The nomogram prediction model constructed can provide a visual and simple evaluation tool for early identification of high-risk children and reducing the occurrence of VAP.