This article analyzes the development and current status of clinical pathways(CPs)in the United States,the European Union,and Japan.CPs are standardized treatment models based on medical evidence and guidelines,aiming to improve therapeutic outcomes,reduce costs,ensure treatment consistency,enhance medical service efficiency,and increase patient satisfaction.The United States has promoted CPs since 1985,driving their development through legislation and professional associations to improve service quality and reduce medical expenditures.The European Union supports the development and evaluation of CPs through the European Pathway Association,emphasizing the improvement of patient treatment outcomes.Japan uses CPs as a tool to improve the quality of medical services,with an emphasis on multidisciplinary collaboration.All three have shown positive effects of CPs in improving medical service efficiency and reducing costs.However,they also face challenges such as overemphasis on cost control,lack of transparency,and physician cooperation.China can draw on these experiences to promote the development of CPs and enhance the quality and efficiency of medical services.

An 87-year-old female patient went to a hospital in Nanshan District on July 18, 2023 because of "vomiting and diarrhea for 2 days". She lived in a nursing home, where 43 similar cases were found within 8 days, including 31 elderly people and 12 caregivers. On July 23, 2023, 13 anal swab samples of the elderly patients were collected, to further find the source of infection, 89 anal swab samples of related nursing assistants and 9 environmental swab samples were collected at the same time. The pathogen was identified by reverse transcription polymerase chain reaction, a total of 22 out of 102 anal swab specimens were positive for Norovirus GⅡ, and the positive rate was 12/13 in the elderly people and 11.23% (10/89) in the caregivers, and one norovirus GⅡ positive sample among 9 environmental smear samples. The polymerase region and partial gene sequences of the capsid VP1 region were amplified and sequenced for the Norovirus-positive specimens, among which 20 strains were successfully sequenced and showed GⅡ.4[P16] under the Norovirus online typing tool. The sequences of 11 elderly people were highly homologous to those of 9 caregivers, with a homology of 95% in the polymerase region and 99% in the capsid VP1 region, which had sequence homology of 99% compared with the Genbank reference sequences of OP009779 (2022 Chengdu strain), OQ930719 (2023 Nanjing strain), and OL336359 (2021 Beijing strain).

An 87-year-old female patient went to a hospital in Nanshan District on July 18, 2023 because of "vomiting and diarrhea for 2 days". She lived in a nursing home, where 43 similar cases were found within 8 days, including 31 elderly people and 12 caregivers. On July 23, 2023, 13 anal swab samples of the elderly patients were collected, to further find the source of infection, 89 anal swab samples of related nursing assistants and 9 environmental swab samples were collected at the same time. The pathogen was identified by reverse transcription polymerase chain reaction, a total of 22 out of 102 anal swab specimens were positive for Norovirus GⅡ, and the positive rate was 12/13 in the elderly people and 11.23% (10/89) in the caregivers, and one norovirus GⅡ positive sample among 9 environmental smear samples. The polymerase region and partial gene sequences of the capsid VP1 region were amplified and sequenced for the Norovirus-positive specimens, among which 20 strains were successfully sequenced and showed GⅡ.4[P16] under the Norovirus online typing tool. The sequences of 11 elderly people were highly homologous to those of 9 caregivers, with a homology of 95% in the polymerase region and 99% in the capsid VP1 region, which had sequence homology of 99% compared with the Genbank reference sequences of OP009779 (2022 Chengdu strain), OQ930719 (2023 Nanjing strain), and OL336359 (2021 Beijing strain).

This article analyzes the development and current status of clinical pathways(CPs)in the United States,the European Union,and Japan.CPs are standardized treatment models based on medical evidence and guidelines,aiming to improve therapeutic outcomes,reduce costs,ensure treatment consistency,enhance medical service efficiency,and increase patient satisfaction.The United States has promoted CPs since 1985,driving their development through legislation and professional associations to improve service quality and reduce medical expenditures.The European Union supports the development and evaluation of CPs through the European Pathway Association,emphasizing the improvement of patient treatment outcomes.Japan uses CPs as a tool to improve the quality of medical services,with an emphasis on multidisciplinary collaboration.All three have shown positive effects of CPs in improving medical service efficiency and reducing costs.However,they also face challenges such as overemphasis on cost control,lack of transparency,and physician cooperation.China can draw on these experiences to promote the development of CPs and enhance the quality and efficiency of medical services.

Background: Circular RNAs (circRNAs) is correlated with the development and progression of malignant tumor. Recent studies have shown the potentials of some circRNAs in the early diagnosis, screening of therapeutic targets and prognostic judgment of gastric cancer. Aims: To investigate the serum circNRIP1 expression and its clinical significance in the diagnosis, treatment and prediction of prognosis of gastric cancer. Methods: A total of 76 gastric cancer patients diagnosed by pathology from September 2016 to September 2019 at Dujiangyan People's Hospital were enrolled, and 63 healthy individuals were served as controls. Serum circNRIP1 expression was detected by real time fluorescent quantitative PCR, and its correlation with clinicopathological features was analyzed. ROC curve was used to analyze the diagnostic efficiency. Results: Serum circNRIP1 expression in gastric cancer group was significantly higher than that in healthy control group (P<0.01). The circNRIP1 expression in gastric cancer patients was significantly correlated with the differentiation of tumor cells, depth of infiltration, lymph node metastasis and TNM stage (P<0.05). Serum circNRIP1 expression in gastric cancer patients after operative treatment was significantly lower than that before treatment (P<0.05). After 2 years follow-up, serum circNRIP1 expression in survival group was significantly lower than that in death group (P<0.05). ROC curve analysis showed that the sensitivity of serum circNRIP1 expression for gastric cancer was 88.9%, the specificity was 88.2%, and AUC was 0.876. Conclusions: Detecting serum circNRIP1 expression has significant value in the early diagnosis and evaluation of treatment and prediction of prognosis of gastric cancer.

Objective:To observe the local reactions and efficacy of CD19 CAR-T therapy in recurrence/refractory B-cell non-Hodgkin's lymphoma (R/R NHL) patients with >7.5 cm lesions.Methods:32 R/R NHL patients with >7.5 cm lesions were enrolled and injected with CD19 CAR-T cells. Flow cytometry was used to detect and observe the amplification of CD19 CAR-T cells in vivo. Enzyme-linked immunosorbent assay (ELISA) was used to detect cytokines in peripheral blood of patients. The side effects of CD19 CAR-T cell therapy included systemic side effects and local reactions of tumor. The local side effects were observed by Ultrasound, Computed tomography and Magnetic resonance imaging. Treatment options included glucocorticoid, interleukin-6 antibody and drainage of exudate. Overall response rate (ORR) and overall survival rate (OS) were observed.Results:①Among the 32 patients, CR (40.63%) , PR (31.25%) and ORR (71.88%) were 13, 10 and 23, respectively. ②In all 23 patients received ORR, 13 patients had grade 1-2 CRS, while 10 patients had grade 3-4 CRS. All the 9 patients in the SD+PD group had grade 1-2 CRS ( P=0.030) . ③A total of 15 patients with tumor local reactions, included 9 patients with CR, 5 patients with PR and 1 patient with SD. The local reactions of the tumor included that the diameter of the superficial lesions increased with redness, swelling and heat pain. The deep lesions presented abdominal pain, abdominal distension, suffocation and local pain, and burning of the tumor. The deep lesions were enlarged or accompanied by local edema. The local exudative lesions were found in the abdominal cavity and pleural cavity. ④ Peak proportion of CD19 CAR-T cells in ORR group was higher than that of in SD+PD group[16.8% (5.3%-48.2%) vs 2.9% (1.5%-5.7%) , z=-4.297, P<0.001]. The peak proportion of CD19 CAR-T cells in ORR group with local reactions was higher than that of in patients without local reactions [22.2% (10.5%-48.2%) vs 12.6% (5.3%-21.6%) , z=-3.213, P=0.001]. The peak proportion of CD19 CAR-T cells in multiple lesion group was higher than that of in single lesion group [35.8% (1.5%-48.2%) vs 16.8% (10.5%-18.5%) , z=-2.023, P=0.040]. ⑤Occurrence of local reactions and tumor shrinkage time were both delayed compared with systemic side effects. ⑥In the ORR group, the OS of patients with tumor local reactions was longer than that of patients without tumor local reactions, but there was no difference in the two groups (75% vs 34.6%, P=0.169) . Conclusions:CD19 CAR-T cell therapy in R/R NHL patients with >7.5 cm lesions might cause tumor local reactions later than systemic side effects.Clinicaltrial::ChiCTR1800018059

Objective:To explore the effects of bridge in, objective, pre-assessment, participatory learning, post-assessment and summary (BOPPPS) on internal nursing teaching.Methods:Totally 220 nursing students enrolled into Zhengzhou University in 2017 were selected by convenient sampling and divided into the observation group and the control group according to the teaching mode, with 110 nursing students in each group. Nursing students in the control group receiving traditional teaching, while nursing students in the control group receiving BOPPPS teaching. The effect of the two teaching modes was compared.Results:The satisfaction rate of the observation group (98.2%) was higher than that of the control group (90.0%) , and the difference was statistically significant ( P<0.05) . The assessment results of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . The total score of self-evaluation of learning effect and the score of each dimension in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The BOPPPS model shows satisfying effects in internal nursing teaching, which can increase the satisfaction of students with the teaching mode, and enhance their interest in learning, academic performance, and learning evaluation.

AIM To optimize the ultrasound-microwave extraction for total flavonoids from Glycyrrhizae Radix et Rhizoma residue by response surface method.METHODS In addition to the index of extraction rate of total flavonoids for evaluation,the microwave power,extraction time,liquid-soild ratio and ethanol concentration were taken into consideration as influencing factors for the extraction optimization by response surface method on the basis of single factor test.RESULTS The optimal conditions,determined to be 125 W for microwave power,32 min for extraction time,28.4 ∶ 1 for liquid-solid ratio,79％ for ethanol concentration,and 300 W for extraction power,could bring forth a 2.59％ extraction rate of total flavonoids.CONCLUSION This stable and reliable method can be used for extracting total flavonoids from Glycyrrhizae Radix et Rhizoma residue.

OBJECTIVE: To investigate the risk factors for type 2 diabetes complicated with hypertension in adult residents in Liuyang, Hunan Province, P. R. China.
 METHODS: The residents aged at or over 18 were selected through a method of multi-stage cluster random sampling from 10 towns in Liuyang. Questionnaires, physical measurements and laboratory tests were conducted. Type 2 diabetes complicated with hypertension were served as an experimental group, while simple diabetes, non-diabetes and non-hypertension (healthy control), or non-complication and healthy group (simple hypertension, simple diabetes, and healthy group) were served as control group, respectively. Three kinds of logistic regression model were used to analyze the risk factors for type 2 diabetes complicated with hypertension.
 RESULTS: A total of 5 669 residents were included in the analysis, and the response rate was 97.74%. The results showed that the prevalence of type 2 diabetes complicated with hypertension of residents at or over 18 years old in Liuyang was 2.6% (95%CI: 2.2%, 3.1%). Logistic regression analyses demonstrated that for people at or over 60 years old, obesity and abnormal triglyceride were the independent risk factors for type 2 diabetes complicated with hypertension.
 CONCLUSION Aging, obesity and abnormal triglyceride can increase the risk of type 2 diabetes complicated with hypertension in adult residents in Liuyang.
Adult ; Aging ; China ; epidemiology ; Diabetes Mellitus, Type 2 ; complications ; epidemiology ; Humans ; Hypertension ; complications ; epidemiology ; Logistic Models ; Obesity ; epidemiology ; Prevalence ; Risk Factors ; Surveys and Questionnaires ; Triglycerides ; blood