OBJECTIVE To evaluate the comprehensive value of novel oral anticoagulant drugs （NOACs） after major orthopedic surgery. METHODS The evaluation evidence was collected through literature research； evidence and value：impact on decision-making （EVIDEM） framework was introduced to integrate the evaluation process； the multi-criteria decision analysis （MCDA） method was used to construct a multi-dimensional evaluation system； the weights assigned to each evaluation criterion were determined by the combination of Delphi method and analytic hierarchy process， and the rivaroxaban， dabigatran and apixaban were comprehensively evaluated. RESULTS The clinical comprehensive evaluation system of NOACs after major orthopedic surgery was successfully established， and the final clinical comprehensive evaluation weights of NOACs （rivaroxaban， dabigatran， apixaban） after major orthopedic surgery were calculated， with scores of 0.399 7 for rivaroxaban， 0.244 4 for apixaban， and 0.355 9 for dabigatran， indicating that rivaroxaban demonstrated the highest overall clinical value. Among them， rivaroxaban had the highest weight score in the evaluation of pharmaceutical characteristics， cost-effectiveness and other attributes in a single dimension. In terms of efficacy and safety evaluation， apixaban had the highest weighting score. CONCLUSIONS Among NOACs， rivaroxaban is more suitable for routine anticoagulation management after major orthopedic surgery， especially in terms of pharmacological properties， cost-effectiveness and other attributes.

Objective To investigate the clinical diagnostic value of plasma serine protease inhibitor Ka-zal-type 4(SPINK4)expression in colorectal adenocarcinoma(CRC)and progressive adenoma(AA).Methods A total of 62 patients with CRC(CRC group)and 15 patients with AA(AA group)diagnosed by colonoscopy and pathological examination in this hospital from June 2020 to December 2021 were selected,and 22 healthy people undergoing physical examination during the same period were selected as the HC group.The expression of SPINK4 in plasma was detected by ELISA,and the expression of CEA in plasma was detected by electrochemiluminescence,and the correlation was analyzed.The diagnostic efficiency was analyzed by re-ceiver operating characteristic(ROC)curve,and the expression of p53 in CRC tissues was detected by immu-nohistochemistry.Results The expression of plasma SPINK4 in the CRC group and AA group was lower than that in the HC group(Z=3.72,-0.41,P＜0.05),and the expression of CEA in the CRC group was higher than that in the HC group(Z=-3.63,P＜0.05).The area under the curve(AUC),accuracy,sensi-tivity and specificity of SPINK4 combined with CEA in the diagnosis of CRC and AA were higher than those of SPINK4 and CEA alone.The positive rate of mutant type p53 in SPINK4 low expression group and CEA high ex-pression group was significantly increased in CRC patients(72.55％,75.00％,P＜0.05).Conclusion The expression of plasma SPINK4 is decreased in CRC and AA,and the combined detection of SPINK4 and CEA has a good di-agnostic efficiency in CRC and AA.

Purpose::To assess the value of the driving pressure variation rate (ΔP%) in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.Methods::In this case-control study, a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled. Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days. Outcome measures including driving pressure, PaO 2:FiO 2, and positive end-expiratory pressure, etc. were assessed every 24 h from day 0 to day 14 until successful weaning was achieved. The measurement data of non-normal distribution were presented as median (Q 1, Q 3), and the differences between groups were compared by Wilcoxon rank sum test. And categorical data use the Chi-square test or Fisher's exact test to compare. The predictive value of ΔP% in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves. Results::Of the total 35 patients included in the study, 17 were successful vs. 18 failed in weaning from a ventilator after 14 days of mechanical ventilation. The cut-off values of the median ΔP% measured by Operator 1 vs. Operator 2 in the first 4 days were ≥ 4.17% and 4.55%, respectively ( p < 0.001), with the area under curve of 0.804 (sensitivity of 88.2%, specificity of 64.7%) and 0.770 (sensitivity of 88.2%, specificity of 64.7%), respectively. There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group (8 (6, 13) vs. 12 (7.5, 17.3), p = 0.043). The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group (0.2‰ vs. 2.3‰, p = 0.001). There was a significant difference noted between these 2 groups in the 28-day mortality (11.8% vs. 66.7%, p = 0.003). Conclusion::The median ΔP% in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days. Further study is needed to confirm this finding.

The biological clock(also known as the circadian rhythm)is the fundamental reliance for all organisms on Earth to adapt and survive in the Earth's rotation environment.Circadian rhythm is the most basic regulatory mechanism of life activities,and plays a key role in maintaining normal physiological and biochemical homeostasis,disease occurrence and treatment.Recent studies have shown that the biologi-cal clock plays an important role in the development of oral tissues and in the occurrence and treatment of oral diseases.Since there is cur-rently no guiding literature on the research methods of biological clock in stomatology,researchers mainly conduct research based on pub-lished references,which has led to controversy about the research methods of biological clock in stomatology,and there are many confusions about how to rationally apply the research methods of circadia rhythms.In view of this,this expert consensus summarizes the characteristics of the biological clock and analyzes the shortcomings of the current biological clock research in stomatology,and organizes relevant experts to summarize and recommend 10 principles as a reference for the rational implementation of the biological clock in stomatology research.

To effectively introduce and utilize global advanced educational resources, the implementation of Chinese-foreign joint education program in medical universities and the establishment of an internal quality assurance system with Chinese characteristics and substantially equivalent to international standards of medical education is crucial for improving the quality of Chinese medical talent cultivation and achieving high-quality development of education opening up to the outside world in the new era. Using the Chinese-Foreign Joint Education Program jointly run by Chongqing Medical University and University of Leicester as an example, this paper proposes a plan for the development of an internal quality assurance system with three core indicators of management mechanism, team building, and student services. This plan provides experience and a reference for domestic universities to carry out cross-border medical education and improve the quality and efficiency of Chinese-foreign joint education programs.

Objective To compare image quality of 5.0T and 3.0T time of flight MR angiography(TOF-MRA)and displaying choroidal anterior arteries(AChA).Methods Data of 80 patients who underwent head 5.0T(5.0T group,n=40)and/or 3.0T TOF-MRA(3.0T group,n=42)were retrospectively analyzed,among them 2 patients underwent both 5.0T and 3.0T TOF-MRA.The subjective scoring and objective evaluation of image quality were performed,and the results were compared between groups.AChA was divided into proximal,intermediate and distal segments(A1,A2,A3 segment),the quantity of left and right AChA shown on 5.0T and 3.0T TOF-MRA were recorded,and the length and diameter of left and right AChA dispalyed on MRA were comparatively observed.Results The subjective scores of image quality of 5.0T group were higher than that of 3.0T group(5.0[4.0,5.0]vs.5.0[3.0,5.0],Z=6.417,P=0.029).The signal-to-noise ratio(91.01±5.04)and contrast-to-noise ratio(72.47±5.14)of 5.0T group were both larger than those of 3.0T group([62.11±4.16],[48.92±4.62],t=28.339,19.681,both P＜0.001).There were 80 segments of AChA-A1,80 of AChA-A2 and 60 segments of AChA-A3 displayed on 5.0T TOF-MRA,while 60 segments of AChA-A1,36 of AChA-A2 and 12 segments of AChA-A3 displayed on 3.0T TOF-MRA,respectively.In 5.0T group,the length of the left and right AChA was(24.01±7.41)mm and(22.72±9.36)mm,with diameter of(1.16±0.12)mm and(1.19±0.14)mm,respectively,whereas in 3.0T group,the relative values were(18.35±8.67)mm,(16.80±6.94)mm,(0.99±0.25)mm and(0.95±0.29)mm,respectively,all in 5.0T group were greater than in 3.0T group(t=3.242,3.183,4.595,3.846,all P＜0.001).Conclusion Compared with 3.0T TOF-MRA,5.0T TOF-MRA of AChA might provide better image quality and clearer vessel depiction,being helpful to clinical diagnosis and treatment of ACHA-related cerebral vascular diseases.

Objective To compare image quality of 3.0T and 5.0T MR cholangiopancreatography(MRCP).Methods Eighteen patients with bile duct dilation(bile duct dilation group)and 7 healthy volunteers(healthy group)were prospectively enrolled.MRCP was performed with 3.0T and 5.0T scanners,respectively,and the ability for displaying details of bile duct tree,signal-to-noise ratio(SNR)and image artifacts were compared between 3.0T and 5.0T MRCP.Results In bile duct dilation group,the number of branches,total branch length and the maximum branch length of bile duct tree on 5.0T MRCP were all greater than those on 3.0T MRCP(all P＜0.05).In healthy group,the number of branches and total branch length of bile duct tree on 5.0T MRCP were both greater than those on 3.0T MRCP(both P＜0.05).In both groups,the SNR of 5.0T MRCP was greater than that of 3.0T MRCP,but the difference was not significant(both P＞0.05).No significant difference of image artifacts was found between 3.0T and 5.0T MRCP(P=0.054).Conclusion 5.0T MRCP might display better anatomical details of bile duct tree than 3.0T MRCP,with SNR and image artifacts comparable to 3.0T MRCP.

Humans ; Propionic Acidemia/complications* ; Cardiomyopathy, Dilated/etiology*

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.
Humans ; Consensus ; Critical Care/methods* ; Intensive Care Units ; Pain/drug therapy* ; Analgesics/therapeutic use* ; Delirium/therapy* ; Critical Illness

Electronic tongue is one kind of bionic detection technologies, which can objectively reflect the taste of drugs based on electrochemical principle. In this paper, the development histories of electronic tongue both of potential type and voltammetry type were introduced, including their detection principles and key innovation technologies. In order to comprehensively improve the understanding of electronic tongue, its technological progresses, such as the study of dedicated sensors or biosensors for specific tastes, and the development of miniaturized or hybrid devices, were also discussed in detail. And the challenges and countermeasures in the application of electronic tongue were analyzed to provide some suggestions for its further technology promotion.