Point-of-care testing (POCT) provides key support for clinical decision-making through rapid detection. This article introduces the development background of POCT in the field of pre-hospital emergency, as well as the development status of POCT in Hangzhou City, and analyzes the problems of quality management. Pre-hospital emergency medical institutions in Hangzhou City have been equipped with POCT equipment, and the test items include blood glucose, cardiac troponin, etc. The implementation rates of internal quality control, comparison test, and proficiency testing were 58.2%, 50.3% and 42.6%, respectively. POCT quality management has problems such as unclear responsibility subjects, insufficient professional personnel, and a lack of standardization of the process. It is proposed to build a hierarchical collaborative management system, strengthen the double access mechanism of personnel and equipment, implement the whole process quality control, and build a digital management platform, so as to provide the reference for the high-quality development of POCT in pre-hospital medical emergency institutions.

Outpatient humanistic care refered to providing a full process of caring medical services to outpatients. In order to standardize the human caring services for outpatients in medical institutions, promote the comprehensive service level of outpatient services, and improve the patient′s medical experience, Chinese Association for Life Care issued the group standard of Management Norms for Human caring of Outpatients in April 2023. This standard clarified the relevant terms and definitions of human caring for outpatients, specified the basic requirements for human caring, the humanistic quality and care responsibilities of outpatient staff, the outpatient care environment and facilities, the outpatient care process and measures, and quality management. It designed standardized and personalized full process care service norms, providing references for medical institutions at all levels to promote the development of human caring for outpatients.

ObjectiveThis study aims to investigate the effect of modified Baitouwengtang （MBTWD） on tumor growth and the number of tumor-associated macrophages （TAMs） in tumor tissue of MC38 cell tumor-bearing mice with colorectal cancer and explores whether MBTWD mediates the remodeling of TAM phenotype to play an immunologically antitumor effect. MethodFirstly， The C57BL/6 mouse tumor model grafted subcutaneously was established， and then model mice were classified into a model group， positive control group（3 mg·kg^-1）， and MBTWD groups with high and low dosages（23.43、46.86 g·kg^-1）， with 10 mice in each group. In addition， 10 healthy mice were set as the blank group， and the changes in body weight， tumor volume， and survival status of mice in each group were observed. Tumor tissue， spleen， and peripheral blood were collected to calculate the tumor volume change， tumor inhibition rate， and spleen mass. Hematoxylin-eosin （HE） staining was used to observe the morphological changes of tumor tissue， and an immunofluorescence assay was used to detect the expression levels of CD4， CD8， and CD206 in tumor tissues of tumor-bearing mice. The secretion levels of transforming growth factor （TGF）-β， interleukin （IL）-6， and chemokine （C-C Motif） ligand 2 （CCL2） in peripheral serum were measured by using enzyme-linked immunosorbent assay （ELISA）. Secondly， a co-culture model induced by IL-4 in vitro of MC38 cells and murine monocytic macrophage RAW264.7 cells was established. Cell proliferation and activity assay （CCK-8） was used to detect the inhibitory effect of MBTWD containing serum on cell proliferation. A transwell experiment was used to detect the effect of IL-4-induced M2 macrophages on the invasion of MC38 cells. Flow cytometry was used to detect the expression of CD86 on the membrane of M2 macrophages induced by IL-4 with MBTWD containing serum. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the effect of MBTWD containing serum on the mRNA expression levels of M1 macrophage-related polarization factors CD86， nitric oxide synthase （iNOS）， and IL-12， as well as M2 macrophage-related polarization factors CD206， CD163， and IL-10 after co-cultivation. Finally， the protein expression levels of colony-stimulating factor 1 receptor （CSF1R）， stimulator of interferon genes （STING）， and TANK binding kinase 1 （TBK1） in tumor tissues of tumor-bearing mice were detected by Western blot. ResultIn vivo experimental results show that compared with the model group， the MBTWD can significantly inhibit the tumor growth of tumor-bearing mice. Immunofluorescence experiments show that the MBTWD can increase the number of CD8⁺ T cell infiltration in tumor tissue of tumor-bearing mice， reduce the number of CD206⁺ TAMs infiltration， and down-regulate the secretion levels of cytokines IL-6， TGF-β， and CCL2 in peripheral blood of tumor-bearing mice. The results of in vitro experiments show that the MBTWD containing serum has no obvious inhibitory effect on cell proliferation， but the cell supernatant after co-cultivation with RAW264.7 cells can inhibit the proliferation activity of MC38 cells， and the invasion ability of MC38 cells is enhanced by IL-4-induced M2 macrophages. However， this effect can be inhibited in a concentration-dependent manner by the MBTWD containing serum. At the same time， the results of Real-time PCR show that the MBTWD containing serum can up-regulate the mRNA expression levels of M1 macrophage-related polarization factors CD86， iNOS， and IL-12 and down-regulate those of M2 macrophage-related polarization factors CD206， CD163， and IL-10. Flow cytometry results also confirm that the MBTWD containing serum can increase the number of repolarized CD86⁺ M1 macrophages， indicating that MBTWD can induce M2 macrophages to repolarized M1 macrophages to play an anti-tumor growth role. Finally， Western blot results show that MBTWD can down-regulate the expression of CSF1R protein and up-regulate that of STING and TBK1 proteins in tumor tissue of tumor-bearing mice. ConclusionMBTWD can down-regulate the infiltration number of CD206⁺ TAMs and increase the infiltration of CD8⁺ T cells， thereby playing an immunologically antitumor effect on the growth inhibition of colorectal cancer， which may be related to regulating CSF1R signaling and then activating STING/TBK1 signaling pathway to induce phenotypic remodeling of TAMs.

Objective:To investigate the clinical diagnostic value of MRI retention enema cannula enhanced scanning in the high complex anal fistula.Methods:The clinical data of 60 anal fistula patients underwent surgery treatment from May 2020 to May 2022 in Affiliated Hospital of Shanxi University of Traditional Chinese Medicine were retrospectively analyzed. All patients underwent MRI plain scanning and enhanced scanning before operation. Compared with the surgical results, the difference between MRI plain scanning and enhanced scanning in the diagnosis of high complex anal fistula was compared.Results:All of the 60 patients successfully completed surgical treatment, and 58 cases internal orifices, 55 cases complex anal fistulas and 53 cases high anal fistulas were found intraoperatively. MRI plain scanning results showed 32 cases internal orifices, 46 cases complex anal fistulas and 42 cases high anal fistulas were found. MRI enhanced scanning results showed 54 cases internal orifices, 53 cases complex anal fistulas and 50 cases high anal fistulas were found. Based on surgical results, the coincidence rates of internal orifice, complex anal fistula and high anal fistula in MRI enhanced scanning were significantly higher than those in MRI plain scanning: 93.10% (54/58) vs. 55.17% (32/58), 96.36% (53/55) vs. 83.64% (46/55) and 94.34% (50/53) vs. 79.25% (42/53), and there were statistical differences ( χ2 = 21.76, 4.95 and 5.27; P<0.01 or <0.05). Conclusions:The MRI retention enema cannula enhanced scanning has obvious advantages in the diagnosis of high complex anal fistula, which provides scientific reference value for the diagnosis and operation of high complex anal fistula in clinic.

Objective:To summarize the experience of ambulance medical support in the 19th Hangzhou Asian Games, and provide reference for the ambulance medical support work of large-scale sports events in the future.Methods:According to the actual situation of the Asian Games, the objectives of the medical support were determined according to the principles of highlighting the key points and overall consideration. All kinds of ambulances were allocated according to the principles of combining dynamic and static and regional linkage. The ambulance support was divided into the event side and the city side,with the regional security vehicle as the supplement of the event side and the guarantee of the city side, the implementation of "one pavilion one policy", "one game one policy", "one place one policy" and "one vehicle one plan", and the interconnection of medical points (rooms), designated hospitals, management and command personnel and ambulances were realized through the Asian Games Intelligent Emergency Medical Support Syetem (EMSS).Results:Between September 16, 2023, 08:00, and October 9, 2023, 08:00, a total of 207 ambulances were deployed during the 19th Hangzhou Asian Games. Of these, 88 (42.5%) were at competition venues, 11 (5.3%) at training venues, 30 (14.5%) at non-competition venues, and 78 (37.7%) were regional support vehicles. Among them, 20 venue ambulances participated in regional support tasks during idle times. Ambulances transported patients from event sites 345 times, with the highest number of transports occurring at competition venues (187 times) and the fewest in the assisting city of Huzhou (6 times). The highest ambulance utilization rate was 70.5% at competition venues, while training venues, non-competition venues, and regional support ambulances had utilization rates of 45.5%, 53.3%, and 42.3%, respectively. The median age of transported individuals was 26 (21, 36), with a majority being male (59.1%). Athletes comprised 52.5% of transports, while staff and spectators accounted for 39.7% and 7.8%, respectively. Joint injuries were the most common condition among transported individuals, totaling 58 cases (16.8%). Regional support ambulances participated in 75 transfers and replacements, with 17 (22.7%) transfers and 58 (77.3%) replacements.Conclusions:This study confirms the feasibility and efficiency of the Asian Games' ambulance support plan, highlighting the crucial role of EMSS. The study suggests the need to strengthen medical support for staff, in addition to athletes.

Objective:To construct an intelligent medical emergency information platform for the 19th Hangzhou Asian Games events and evaluate its practical application.Methods:Addressing the medical support demands for Asian Games, based on the " Emergency medical service system for large-scale social activities" developed by Zhejiang Laboratory, a collaborative team comprising Hangzhou Emergency Center, the Second Affiliated Hospital of Zhejiang University,Zhejiang Lab and College of Biomedical Engineering and Instrument Science of ZhejiangUniversity developed an intelligent medical emergency information platform for the Asian Games. This system was implemented during the 19th Hangzhou Asian Games, collecting basic information, initial diagnosis locations, prognoses, severity grading, and occurrences of infectious diseases for all patients treated at support locations from September 16th to October 8th, 2023. The Modified Early Warning Score (MEWS) was employed for assessing patient conditions, and a symptom monitoring system was used to alert the occurrence of infectious diseases. Post-event, a satisfaction evaluation (on a 5-point scale) regarding the system's application was conducted.Results:The successful construction of the intelligent medical emergency information platform comprised a data dashboard display platform, a comprehensive command system on the management center, and a mobile platform covering on-site medical support, ambulances, and designated hospitals. ①A total of 11 068 patients were treated using this system, including 2 979 athletes, 3 429 staff members, 1 421 volunteers,1 051 spectators, and 2 188 others. The proportion of patients seeking treatment due to illnesses was significantly higher than those due to injuries. Among injury-related cases, athletes constituted 41.37%, while staff accounted for 32.5% of illness-related cases. ②The area under the ROC curve for MEWS regarding hospitalization rates was 0.81 for disease patients and 0.60 for injury patients. ③ There were 211 reported cases of infectious diseases during the event, constituting 1.91% of all treated cases.④ Satisfaction ratings: User-friendliness scored 4.47, completeness of functions scored 4.28, data security scored 4.38, and data accuracy scored 4.49. Compared to traditional paper-based reporting methods, 98.11% of users found the system more convenient, 92.45% were satisfied overall, and the recommendation rating was 4.36.Conclusions:The study findings confirm the critical role played by the information platform in enhancing comprehensive, accurate, timely, secure medical support information dissemination for the Asian Games and in early warning and control of infectious diseases.

The acupuncture method of Shugan-Tiaoshen is proposed by the famous old Chinese medicine Professor Shan Qiuhua in Shandong Province in combination with Traditional Chinese Medicine theory and clinical experience. Shugan-Tiaoshen acupuncture method is widely used in clinic and has curative effect. It can treat mental diseases, nervous system diseases, digestive system diseases, endocrine system diseases, urinary system diseases, diseases caused by physical and chemical factors and other internal diseases, as well as surgical diseases such as skin trauma, facial symptoms and breast diseases. It can also treat gynecological diseases. It can also improve the brain function of stress disorder. The role of soothing liver and regulating spirit in clinic is never underestimated. In clinical practice, doctors should try their best to combine regulating spirit with treating spirit. Shugan-Tiaoshen acupuncture provides a good idea for clinical treatment, but there are still some problems in the current researches, such as the lack of multi-center, large sample trials, or well-design mechanism researches.

Objective To study the clinical features,diagnosis,treatment and prognosis of neonatal fulminant myocarditis.Method From January 2016 to August 2016,clinical data of neonates with fulminant myocarditis admitted to the neonatal intense care unit (NICU) were retrospectively collected and analyzed.Result A total of 11 neonates were enrolled,including 6 males and 5 females,and 5 preterms and 6 full term infants.The average gestation age was (37.7 ± 1.6) weeks and their weight on hospital admission was (3 382 ± 675) g.Among the infants,9 got ill in summer and 2 in spring and winter.The onset of illness was within 3 ～ 5 d after birth in 8 cases and 2 ～ 3 weeks in the other 3 cases.The main clinical presentations included fever,anorexia,shortness of breath and lethargy.Various degrees of cardiac dysfunction appeared in all 11 cases,including cardiogenic shock in 10 cases,severe arrhythmias with multiple organ dysfunction in 7 cases,and viral meningitis in 7 cases.10 infants had significantly elevated brain natriuretic peptide (BNP) and troponin Ⅰ,and those with troponin Ⅰ above 20 μg/L had poor prognosis.A comprehensive treatment of limiting liquid volume,high-dose adrenocortical steroids,and IVIG were carried out.Meanwhile,therapy to prevent shock,improve cardiac function,reverse arrhythmia,and mechanical ventilation were used in children with dyspnea.7 cases were cured and 6 patients were followedup for 6 to 12 months.Among the 6 followed-up patients,within 1 ～3 months after discharge,4 cases had normal echocardiogram,and persistently abnormal echocardiogram were found in the other 2 cases and eventually confirmed as dilated cardiomyopathy.4 patients were dead.Conclusion The clinical manifestations of neonatal fulminant myocarditis are unspecific.It's difficult to recognize the early symptoms,missed and delayed diagnosis are common,resulting in high mortality rate.Timely diagnosis and effective treatment can improve the survival rate.

Objective To investigate the value of mammotome minimally invasive puncture drainage in the treatment of breast abscess.Methods 53 patients with the breast abscess were divided into minimally invasive group (27 cases)and open group(26 cases)according to the principle of completely random.The patients in the minimally invasive group were treated with mammotome minimally invasive puncture drainage under the ultrasound guidance.The patients in the open group underwent conventional breast abscess incision and drainage.All the patients were treated with systemic anti -infection and symptomatic treatment.Then,we collated and analyzed the statistical data from the operation time,postoperative pain time,pain degree,number of dressing,healing time,postoperative breast feeding and breast appearance aspects.Results There was no significant difference in operation time between the two groups.In the minimally invasive group,the time of pain,the degree of pain,the time of dressing change,the healing time,the proportion of nursing and the appearance of the breast were (2.6 ±0.8)d,(2.1 ±0.2)min,(7.3 ±0.6)times, (1 8.0 ±0.1 )d,81 .5%,(3.5 ±0.2)points respectively.Those in the open group were (5.2 ±0.2)d,(3.3 ± 0.3)min,(28.0 ±0.2)times,(30.0 ±0.8)d,26.9%,(2.1 ±0.2)points respectively.The differences between the two groups were statistically significant(t =-3.38,-5.1 2,-5.61 ,-5.39,χ2 =32.25,t =-6.1 2,all P <0.05). Conclusion Minimally invasive treatment is a good method in the treatment of breast abscess,and deserved to be promoted clinically.

Objective To investigate the clinical application value of ductoscopic flushing in the treatment of early lactation acute mastitis.Methods 52 patients with early acute mammitis were divided into observation group (27 cases)and control group(25 cases)according to the principle of completely random.In the observation group, the patients were checked under the intervention of mammary duct firstly,and then the disease regions of the breast were flushed using ductoscope.In the control group,the patients were treated with artificial breast -milk.The two groups were all treated with the same antibiotics.The curative effect of the two groups was observed,and the statistical analysis was performed.Results In the observation group,the mass extinction time,pain relief time,pyretolysis time, hemogram recovery time,contralateral continued breast -feeding proportion,the proportion of abscess formation,the proportion of back -milk,the proportion of ipsilateral quadrant recurrence were (3.5 ±1.2)h,(5.0 ±0.9)h, (1.0 ±0.1)d,(1.0 ±0.3)d,92.6%,7.4%,7.4%,0.0% respectively,those in the control group were (24.0 ± 3.2)h,(2.0 ±2.1)h,(2.0 ±0.2)d,(3.0 ±0.3)d,88.0%,12.0%,12.0%,8.0% respectively.The differences between the two groups were statistically significant(t =1.72,0.36,0.43,0.72,χ2 =1.83,2.02,1.56,0.34,all P <0.05).Conclusion Ductoscopic flushing has good effect in the treatment of early lactation acute mastitis,and it is worthy of clinical promotion.