Objective Based on the"preventive treatment of disease"theory and real-world data,this study aimed to evaluate the clinical efficacy of Yangyin Shugan Formula in patients with ovarian dysfunction characterized by the syndrome of kidney deficiency and liver depression at different stages and to provide evidence for optimizing the timing of traditional Chinese medicine(TCM)in premature ovarian insufficiency(POI)management.Methods Ovarian dysfunction patients under 40 years old characterized by syndrome of kidney deficiency and liver depression,registered in the outpatient electronic medical records of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to December 2023,were stratified into three groups:subclinical POI,POI,and premature ovarian failure(POF)groups.The therapeutic outcomes of the three groups of patients were compared,including TCM syndrome total response rates,menstrual total response rates/normalization(cured)rates,base follicle-stimulating hormone(FSH)total response rate/normalization rates and anti-Müllerian hormone(AMH)levels.Results A total of 307 patients meeting the research criteria were included(97 cases in subclinical POI group,112 cases in POI group,and 98 cases in POF group).The TCM syndrome total response rates ranked as subclinical POI group(98.97%,96/97)>POI group(95.54%,107/112)>POF group(83.67%,82/98),with the POF group was lower than that of the subclinical POI and POI groups(P<0.017);while the difference of the subclinical POI group with the POI group was not significant.Menstrual total response rates ranked as subclinical POI group(97.22%,70/72)>POI group(72.32%,81/112)>POF group(51.02%,50/98),the differences among the three groups and in the post-hoc comparisons were significant(P<0.01,P<0.017);normalization rates ranked as subclinical POI group(90.28%,65/72)>POI group(54.46%,61/112)>POF group(26.53%,26/98),the differences among the three groups and in the post-hoc comparisons were significant(P<0.01,P<0.017).FSH total response rates ranked as subclinical POI group(89.69%,87/97)>POI group(81.25%,91/112)>POF group(60.20%,59/98),while POF group was lower than that of the other two groups(P<0.017),and the difference of the subclinical POI group with the POI group was not significant.Normalization FSH rates ranked as subclinical POI group(71.13%,69/97)>POI group(53.57%,60/112)>POF group(16.33%,16/98),the differences among the three groups and in the post-hoc comparisons were significant(P<0.01,P<0.017).Compared with before treatment,the FSH levels in all three groups decreased after treatment(P<0.01).The reduction of FSH in the POF and POI groups were better than that in the subclinical P OI group(P<0.017).No significant difference was observed in the reduction of FSH between the POI and POF groups.Post-treatment AMH elevation observed in the subclinical POI and POI groups(P<0.01).Conclusion Yangyin Shugan Formula improves the menstrual conditions and TCM syndromes across all the stages.It also improves elevated FSH levels across all the stages and has a specific effect on normalizing FSH and menstruation.Yangyin Shugan Formula increases the AMH levels of patients with subclinical POI and POI,highlighting the applicability of TCM in staged preventive management.

Objective Based on the"preventive treatment of disease"theory and real-world data,this study aimed to evaluate the clinical efficacy of Yangyin Shugan Formula in patients with ovarian dysfunction characterized by the syndrome of kidney deficiency and liver depression at different stages and to provide evidence for optimizing the timing of traditional Chinese medicine(TCM)in premature ovarian insufficiency(POI)management.Methods Ovarian dysfunction patients under 40 years old characterized by syndrome of kidney deficiency and liver depression,registered in the outpatient electronic medical records of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to December 2023,were stratified into three groups:subclinical POI,POI,and premature ovarian failure(POF)groups.The therapeutic outcomes of the three groups of patients were compared,including TCM syndrome total response rates,menstrual total response rates/normalization(cured)rates,base follicle-stimulating hormone(FSH)total response rate/normalization rates and anti-Müllerian hormone(AMH)levels.Results A total of 307 patients meeting the research criteria were included(97 cases in subclinical POI group,112 cases in POI group,and 98 cases in POF group).The TCM syndrome total response rates ranked as subclinical POI group(98.97%,96/97)>POI group(95.54%,107/112)>POF group(83.67%,82/98),with the POF group was lower than that of the subclinical POI and POI groups(P<0.017);while the difference of the subclinical POI group with the POI group was not significant.Menstrual total response rates ranked as subclinical POI group(97.22%,70/72)>POI group(72.32%,81/112)>POF group(51.02%,50/98),the differences among the three groups and in the post-hoc comparisons were significant(P<0.01,P<0.017);normalization rates ranked as subclinical POI group(90.28%,65/72)>POI group(54.46%,61/112)>POF group(26.53%,26/98),the differences among the three groups and in the post-hoc comparisons were significant(P<0.01,P<0.017).FSH total response rates ranked as subclinical POI group(89.69%,87/97)>POI group(81.25%,91/112)>POF group(60.20%,59/98),while POF group was lower than that of the other two groups(P<0.017),and the difference of the subclinical POI group with the POI group was not significant.Normalization FSH rates ranked as subclinical POI group(71.13%,69/97)>POI group(53.57%,60/112)>POF group(16.33%,16/98),the differences among the three groups and in the post-hoc comparisons were significant(P<0.01,P<0.017).Compared with before treatment,the FSH levels in all three groups decreased after treatment(P<0.01).The reduction of FSH in the POF and POI groups were better than that in the subclinical P OI group(P<0.017).No significant difference was observed in the reduction of FSH between the POI and POF groups.Post-treatment AMH elevation observed in the subclinical POI and POI groups(P<0.01).Conclusion Yangyin Shugan Formula improves the menstrual conditions and TCM syndromes across all the stages.It also improves elevated FSH levels across all the stages and has a specific effect on normalizing FSH and menstruation.Yangyin Shugan Formula increases the AMH levels of patients with subclinical POI and POI,highlighting the applicability of TCM in staged preventive management.

Objective:To investigate the characteristics of HBV-specific T cell reactivity among pregnant, postpartum and non-pregnant women at childbearing age with chronic HBV infection.Methods:A total of 100 patients with chronic HBV infection were enrolled in this study, including 43 pregnant women (pregnant group), 26 patients giving birth within six months (postpartum group), and 31 non-pregnant patients at childbearing age (non-pregnant group). The functional HBV-specific T cells in peripheral blood were detected by ELISPOT. Clinical data as well as the results of virological and serological tests of HBV were collected for stratified analysis.Results:There was no significant difference in the number of functional HBV-specific T cells between the pregnant group and the postpartum group, but the number was significantly lesser in the pregnant group than in the non-pregnant group ( P<0.05). Furthermore, the number of functional HBV-specific T cells was significantly higher in the nucleoside analogues (NUCs)-treated pregnant women than in the NUCs-untreated pregnant women ( P<0.05). Among the patients without NUCs treatment, there were no significant differences in the numbers of hepatitis B envelope antigen/hepatitis B core antigen (HBeAg/HBcAg)-specific T cells between the pregnant group and the postpartum group, but the numbers were lower in the pregnant group than in the non-pregnant group ( P<0.05). Among the NUCs-treated patients, there was no significant difference in the number of functional HBV-specific T cells between the pregnant group and the non-pregnant group, and the numbers in the two groups were significantly higher than that in the postpartum group (both P<0.05). Additionally, receiver operating characteristic (ROC) curve indicated that the number of functional HBV-specific T cells in combination with HBV DNA load [area under the curve (AUC)=0.807] or hepatitis B surface antigen (HBsAg) levels (AUC=0.916) had a good predictive performance for hepatitis progression during pregnancy. Conclusions:Pregnancy can reduce HBV-specific T cell reactivity in women with chronic HBV infection, but NUCs treatment may improve the function of specific T cells. Routine monitoring of HBV-specific T cells during pregnancy and postpartum period can provide valuable guidance for the evaluation of immune function and treatments.

Public hospitals are pivotal in national health security system.For these hospital,traditional recruitment and employment practices fall short of meeting the multidimensional personnel demands in medical treatment,education,scientific re-search,prevention,and rehabilitation.The Affiliated Brain Hospital of Guangzhou Medical University,a century-old public terti-ary hospital with a diverse personnel composition,has adapted its employment model over nearly 30 years of practice and explora-tion.In response to the hospital's expanding business and strategic planning,it has developed a diverse employment mechanism suitable for talents of all levels.This paper systematically outlines various current employment methods and analyzes the applica-tion and subsequent management of this flexible employment mechanism,expounding its advantages and disadvantages.

Pre-job training for new staff is vital in modern hospital management and talent team construction.This study conducted a survey with a questionnaire and interviews on the satisfaction and effectiveness of pre-job training for 274 new em-ployees of the Affiliated Brain Hospital of Guangzhou Medical University from 2020 to 2022.The results showed over 90％of the new employees were satisfied with course quality and organization and training organization,with the highest scores for hospital history and legal education and legal confidentiality education courses.Pre-job training significantly boosted employee enthusi-asm,organizational identity,and stress regulation capabilities.At the same time,there is room from optimization in aspects such as teaching methods,some course settings,and training schedule arrangements.

Objective Based on the real-world data,we aimed to study the clinical efficacy and safety of Yangyin Shugan(method of nourishing yin and soothing liver)Decoction,an empirical prescription of famous traditional Chinese medicine(TCM)practitioners,in the treatment of premature ovarian insufficiency(POI)with pattern of kidney deficiency and liver depression.Methods A total of 618 POI patients with pattern of kidney deficiency and liver depression who registered in the outpatient electronic medical record system of Guangdong Provincial Hospital of Chinese Medicine were collected from January 2020 to December 2023.After 1:1 propensity matching,a total of 222 patients with POI who met the criteria were included and assigned to a Yangyin Shugan Decoction group(treated with Yangyin Shugan Decoction only)and a hormone control group(hormone treatment only),with 111 cases in each group.Age,age at menarche,marriage status,duration,times of pregnancy,times of miscarriage,menstrual total score,total score of TCM syndrome,basal serum follicle-stimulating hormone(bFSH),and anti-Müllerian hormone(AMH)were recorded and compared.After 3 to 4 months of treatment,the clinical efficacy between the two groups include TCM syndromes,menstrual,bFSH,and menstrual normalization rates during the follow-up period(3 months after discontinuation of medication)were compared.Additionally,comparisons were also made before and after treatment for the total score of TCM syndrome and scores of individual symptom,menstrual total score and scores of indicator,bFSH level,and AMH levels in both groups.Results(ⅰ)The total effective rate of the TCM syndrome in the Yangyin Shugan Decoction group and hormone control group were 85.59%and 52.25%,respectively;the total effective rate of menstrual were 54.95%and 90.99%,respectively;the menstrual normalization rate during the follow-up period were 31.53%and 9.01%,respectively;and regarding bFSH efficacy,the total effective rate were 70.27%and 27.03%,respectively,and the normalization rate of bFSH were 35.14%and 9.01%,respectively.The differences between the two groups were statistically significant(P<0.01).(ⅱ)The bFSH value in the Yangyin Shugan Decoction group decreased after treatment compared to before treatment(P<0.01),while the bFSH value in the hormone control group showed no change before and after treatment.The AMH value increased after treatment compared to before treatment in Yangyin Shugan Decoction group(P<0.01),while the AMH value in the hormone control group showed no change before and after treatment.The difference of bFSH and AMH between the two groups after treatment was statistically significant(P<0.01).(ⅲ)After treatment,the total score of TCM syndrome and the scores of individual symptom in the Yangyin Shugan Decoction group were lower than those before treatment(P<0.01);the total score of TCM syndrome,scores of hot flushes and sweating,hyposexuality,and insomnia in the hormone control group were lower than those before treatment(P<0.01).After treatment,the total score of TCM syndrome and the scores of individual symptom in the Yangyin Shugan Decoction group were lower than those in the hormone control group(P<0.01).(ⅳ)After treatment,the menstrual total score,scores of menstrual cycle,period,menstrual flow,and menstrual blood color in the Yangyin Shugan Decoction group were lower than those before treatment(P<0.01);the menstrual total score,score of menstrual cycle,period,and menstrual flow in the hormone control group were lower than those before treatment(P<0.01);after treatment,the menstrual total score and menstrual cycle score in the hormone control group were better than those in the Yangyin Shugan Decoction group(P<0.01).(ⅴ)No adverse reactions were observed in the Yangyin Shugan Decoction group and 29 cases of adverse reactions were observed in the hormone control group.Conclusion Yangyin Shugan Decoction can effectively improve TCM syndrome in POI patients with pattern of kidney deficiency and liver depression;downregulate the elevated bFSH level,increase the low AMH level,and effectively improve ovarian function,even continue to maintain menstruation after drug withdrawal.In the real world,Yangyin Shugan Decoction got satisfactory efficacy and good safety in the treatment of POI,which deserves clinical promotion and application.

Objective Based on the real-world data,we aimed to study the clinical efficacy and safety of Yangyin Shugan(method of nourishing yin and soothing liver)Decoction,an empirical prescription of famous traditional Chinese medicine(TCM)practitioners,in the treatment of premature ovarian insufficiency(POI)with pattern of kidney deficiency and liver depression.Methods A total of 618 POI patients with pattern of kidney deficiency and liver depression who registered in the outpatient electronic medical record system of Guangdong Provincial Hospital of Chinese Medicine were collected from January 2020 to December 2023.After 1:1 propensity matching,a total of 222 patients with POI who met the criteria were included and assigned to a Yangyin Shugan Decoction group(treated with Yangyin Shugan Decoction only)and a hormone control group(hormone treatment only),with 111 cases in each group.Age,age at menarche,marriage status,duration,times of pregnancy,times of miscarriage,menstrual total score,total score of TCM syndrome,basal serum follicle-stimulating hormone(bFSH),and anti-Müllerian hormone(AMH)were recorded and compared.After 3 to 4 months of treatment,the clinical efficacy between the two groups include TCM syndromes,menstrual,bFSH,and menstrual normalization rates during the follow-up period(3 months after discontinuation of medication)were compared.Additionally,comparisons were also made before and after treatment for the total score of TCM syndrome and scores of individual symptom,menstrual total score and scores of indicator,bFSH level,and AMH levels in both groups.Results(ⅰ)The total effective rate of the TCM syndrome in the Yangyin Shugan Decoction group and hormone control group were 85.59%and 52.25%,respectively;the total effective rate of menstrual were 54.95%and 90.99%,respectively;the menstrual normalization rate during the follow-up period were 31.53%and 9.01%,respectively;and regarding bFSH efficacy,the total effective rate were 70.27%and 27.03%,respectively,and the normalization rate of bFSH were 35.14%and 9.01%,respectively.The differences between the two groups were statistically significant(P<0.01).(ⅱ)The bFSH value in the Yangyin Shugan Decoction group decreased after treatment compared to before treatment(P<0.01),while the bFSH value in the hormone control group showed no change before and after treatment.The AMH value increased after treatment compared to before treatment in Yangyin Shugan Decoction group(P<0.01),while the AMH value in the hormone control group showed no change before and after treatment.The difference of bFSH and AMH between the two groups after treatment was statistically significant(P<0.01).(ⅲ)After treatment,the total score of TCM syndrome and the scores of individual symptom in the Yangyin Shugan Decoction group were lower than those before treatment(P<0.01);the total score of TCM syndrome,scores of hot flushes and sweating,hyposexuality,and insomnia in the hormone control group were lower than those before treatment(P<0.01).After treatment,the total score of TCM syndrome and the scores of individual symptom in the Yangyin Shugan Decoction group were lower than those in the hormone control group(P<0.01).(ⅳ)After treatment,the menstrual total score,scores of menstrual cycle,period,menstrual flow,and menstrual blood color in the Yangyin Shugan Decoction group were lower than those before treatment(P<0.01);the menstrual total score,score of menstrual cycle,period,and menstrual flow in the hormone control group were lower than those before treatment(P<0.01);after treatment,the menstrual total score and menstrual cycle score in the hormone control group were better than those in the Yangyin Shugan Decoction group(P<0.01).(ⅴ)No adverse reactions were observed in the Yangyin Shugan Decoction group and 29 cases of adverse reactions were observed in the hormone control group.Conclusion Yangyin Shugan Decoction can effectively improve TCM syndrome in POI patients with pattern of kidney deficiency and liver depression;downregulate the elevated bFSH level,increase the low AMH level,and effectively improve ovarian function,even continue to maintain menstruation after drug withdrawal.In the real world,Yangyin Shugan Decoction got satisfactory efficacy and good safety in the treatment of POI,which deserves clinical promotion and application.

Objective:To investigate the clinical effect of turbocharged large free anterolateral thigh flaps (ALTF) by anastomosis with a superior perforator of the flap in reconstruction of large soft tissue defects of limbs.Methods:From June 2017 to June 2021, 6 patients with large soft tissue defects of limbs with exposed joints and tendons were treated in the Department of Hand and Foot Surgery of the Affiliated Hospital of Qingdao University with turbocharged large free ALTFs. The pressurised blood supply of ALTF was achieved by anastomosing a superior perforating branch carried in the flap. Such large and turbocharged ALTFs were used to repair large soft tissue defects with exposed joints and tendons in limbs. Of the 6 patients, there were 4 males and 2 females, and aged 32-60(46.0±8.1) years old. Cause of injury: 5 by traffic accident and 1 by machine crush. Four patients had soft tissue defects in lower limbs: 2 with open tibia and fibula fractures, 1 had patellar defect and fibula fracture, and 1 associated with fibula fracture. The other 2 patients had soft tissue defect in upper limbs with bone and tendon exposed but without fracture. The sizes of wound were 25.0 cm×12.0 cm-35.0 cm×19.0 cm. In the primary surgery, Vacuum sealing drainage (VSD) was applied. In the second stage, free ALTFs were used to cover the wound. The area of flap incision was increased by anastomosing the superior perforators and as the consequence, the size of flaps was achieved to 26.0 cm×13.0 cm-36.0 cm×15.0 cm. Donor site of 6 cases were reduced by direct suture, and the remaining wound was covered by free skin graft. Postoperative follow-ups were conducted at outpatient clinic reviews at 1, 2, 3 and 6 months after surgery, and followed by telephone or WeChat interviews. The results of the operation were evaluated according to the appearance, texture and sensory recovery of the flap.Results:All 6 flaps survived and the patients completed the postoperative follow-up that lasted for 6-24 (16.7±5.0) months. No necrosis of flap occurred after surgery. The appearance and texture of the flaps were satisfactory without wear and tear. Sensation recover was evaluated by the standered of British Medical Research Council (BMRC), 4 patients recovered to S 3 and 2 patients to S 2. The Mayo score of the elbow joint was good in 2 patient with upper extremity injuries. Of the other 4 patients with lower limb injuries, the knee function evalued by Hospital for Special Surgery(HSS) score were excellent in 3 patients and good in 1 patient, and the American Orthopedic Foot and Ankle Societ(AOFAS) ankle-hind foot function score was excellent in 2 patients and good in 2 patients. There was no infection or function loss at all donor sites. Conclusion:The perforator of an ALTF is relatively constant, and the flap can partially restore sensation. The superior perforator is reliable and the incision area of the flap can be enlarged by anastomosing the superior perforator vessels. It is a better way to reconstruct a large soft tissue defects in limbs.

Objective: The current investigation aimed to determine the appropriate dosage form by comparing solid dispersion and liposome to achieve the purpose of improving the solubility and bioavailability of linarin. Methods: Linarin solid dispersion (LSD) and linarin liposome (LL) were developed via the solvent method and the thin film hydration method respectively. The Transwell chamber model of Caco-2 cells was established to evaluate the absorption of drug. The pharmacokinetics of linarin, LSD and LL in rats after ig administration were carried out by high performance liquid chromatography (HPLC) method. Results: The solubility of LSD and LL was severally 3.29 times and 3.09 times than that of linarin. The permeation coefficients of LSD and LL were greater than 10

Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.