Medication adherence is an important indicator for assessing whether patients follow medical advice during treatment， and its level directly affects disease control and the quality of life of patients. Therefore， accurate and effective assessment is essential for chronic disease management and intervention. This paper takes chronic obstructive pulmonary disease （COPD） and asthma， two types of chronic respiratory diseases， as representative to review the existing measurement methods and current application status of medication adherence. It is found that the existing assessment methods for medication adherence can be categorized into objective measurement methods and subjective measurement methods. Objective measures include drug concentration monitoring， pill counting， and electronic medication devices， which generally offer high accuracy. Subjective measures include physician assessments， inhalation technique evaluations， and questionnaires. While these methods are straightforward and easy to implement， their accuracy is often influenced by the subjective factors of assessors of patients， which may lead to biased results. Currently， there is still a lack of a universally accepted “gold standard” for evaluating medication adherence. Selecting the appropriate measurement method requires a comprehensive consideration of factors such as research objectives， disease type， patient characteristics， and data availability to ensure the validity and reliability of the assessment results.

Objective:To explore the causal relationship between gut microbiota and lung function (FEV1/FVC) using two-sample Mendelian randomization method; To explore its application in the TCM field.Methods:This was a Mendelian randomization study. The GWAS data of gut microbiota from the MiBioGen consortium study and the GWAS data of lung function (FEV1/FVC) published by IEU OpenGWAS in the public database were used, and instrumental variables were extracted according to prespecified thresholds. The inverse variance weighted method (IVW) was mainly used for analysis. The results were evaluated according to the effect indicator β value and 95% CI. When the IVW method was statistically significant, further sensitivity analysis was performed. Leave-one-out test, heterogeneity test, horizontal gene pleiotropy test and MR-Egger regression intercept analysis were used to verify the stability and reliability of the results. Results:A total of 10 causal relationships between gut microbiota and lung function (FEV1/FVC) were determined using the IVW method: family. BacteroidalesS24.7group ( β=-0.029, P=0.015), family. ClostridialesvadinBB60group ( β=-0.028, P=0.040), family. Streptococcaceae ( β=-0.056, P=0.042), genus. LachnospiraceaeFCS020group ( β=0.025, P=0.029), genus. Lactococcus ( β=-0.024, P=0.038), genus. Peptococcus ( β=0.025, P=0.049), genus. RuminococcaceaeUCG011 ( β=-0.030, P=0.038), genus. Ruminococcus2 ( β=0.028, P=0.033), genus. Terrisporobacter ( β=-0.030, P=0.018), phylum. Cyanobacteria ( β=0.027, P=0.039). Leave-one-out analysis showed that the results were stable, and the effects of heterogeneity and horizontal gene pleiotropy on causal effect estimation could be removed. Conclusion:The gut microbiota may play a role in the changes of lung function, which to a certain extent confirms the TCM theory of "exterior-interior relationship between the lung and large intestine", and can provide certain reference for the research direction of TCM.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective:To summarize the essential elements of clinical doctors′ ward rounds etiquette norms from the perspective of whether doctors′ speech and behavior in actual ward rounds pay attention to patients′ feelings and reflect humanistic care, in order to provide references for improving patients′ treatment effects and medical experience management.Methods:From July to October 2023, a purposeful sampling method was employed to select 16 clinical doctors with ward rounds experience from the eastern, central, western, and northeastern regions across the country. Semi-structured interviews were conducted online via video, focusing on issues related to etiquette norms during ward rounds. The Colaizzi′s seven-step analysis method was used to conduct an inductive analysis of the interview materials.Results:four themes were distilled: friendly and caring body language; accurate, understandable, clear, and timely explanations; appropriate praise and affirmation to encourage patients to actively participate in their disease management; and admonitions to patients and their families regarding disease-related precautions. These four themes were summarized as the " four essentials of ward rounds, " which could be encapsulated as " altruistic inquiry; accurate explanation; affirmative engagement and adequate advice" .Conclusions:The " four essentials of ward rounds" can be made a mandatory part of the clinical doctors′ workflow in the medical quality management process and are recommended for nationwide promotion. This can further enhance the communication skills of clinical doctors, strengthen patients′ trust, improve treatment compliance, and improve doctor-patient relationships, thereby improving the treatment effects, satisfaction, and experience of inpatients.

Objective:To summarize the essential elements of clinical doctors′ ward rounds etiquette norms from the perspective of whether doctors′ speech and behavior in actual ward rounds pay attention to patients′ feelings and reflect humanistic care, in order to provide references for improving patients′ treatment effects and medical experience management.Methods:From July to October 2023, a purposeful sampling method was employed to select 16 clinical doctors with ward rounds experience from the eastern, central, western, and northeastern regions across the country. Semi-structured interviews were conducted online via video, focusing on issues related to etiquette norms during ward rounds. The Colaizzi′s seven-step analysis method was used to conduct an inductive analysis of the interview materials.Results:four themes were distilled: friendly and caring body language; accurate, understandable, clear, and timely explanations; appropriate praise and affirmation to encourage patients to actively participate in their disease management; and admonitions to patients and their families regarding disease-related precautions. These four themes were summarized as the " four essentials of ward rounds, " which could be encapsulated as " altruistic inquiry; accurate explanation; affirmative engagement and adequate advice" .Conclusions:The " four essentials of ward rounds" can be made a mandatory part of the clinical doctors′ workflow in the medical quality management process and are recommended for nationwide promotion. This can further enhance the communication skills of clinical doctors, strengthen patients′ trust, improve treatment compliance, and improve doctor-patient relationships, thereby improving the treatment effects, satisfaction, and experience of inpatients.

【Objective】 To explore the expression of checkpoint kinase 2 (CHEK2) in clear cell renal cell carcinoma (ccRCC), its association with the clinicopathological features and prognosis, and to predict its relevant molecular signaling pathways and biological functions. 【Methods】 The gene expression data, phenotype data, and corresponding survival information of ccRCC patients were downloaded from TCGA database. The optimal cutoff value of CHEK2 was determined with the "survminer" package. The patients were divided into low and high expression groups, and the association between CHEK2 expression and clinicopathological features was analyzed. The correlation between CHEK2 expression and ccRCC prognosis was evaluated with univariate and multivariate Cox proportional hazard models. The changes of cell signaling pathways involved in different CHEK2 expression levels were explored with gene set variation analysis (GSVA). The correlation between CHEK2 and immune cell infiltration as well as immune checkpoint molecular expression was analyzed. 【Results】 CHEK2 expression was significantly higher in ccRCC tissues than in normal tissues (P<0.01). Higher level of CHEK2 was significantly associated with higher T stage of ccRCC (P<0.01). Kaplan-Meier analysis showed overall survival (OS) of patients with high CHEK2 expression were notably decreased (P<0.001). Univariate and multivariate analyses revealed CHEK2 expression as an independent risk factor of survival (HR=1.950, 95%CI: 1.490-2.570, P<0.001; HR=1.588, 95%CI: 1.185-2.127, P=0.002). GSVA showed that CHEK2 was involved in the following pathways: proximal tubule bicarbonate reclamation, propanoate metabolism, limonene and pinene degradation, fatty acid metabolism, primary immunodeficiency, systemic lupus erythematosus, p53 signaling pathway, homologous recombination, DNA replication and mismatch repair. Correlation analysis suggested that CHEK2 was associated with increased infiltration of multiple immune cells in ccRCC and upregulation of various immune checkpoint molecules. 【Conclusion】 The high level of CHEK2 in ccRCC is an independent predicting factor for poor prognosis. It is probably involved in regulating related events of tumor immune infiltration and may become a new target for ccRCC therapy.

Objective To analyze the equity of the allocation of oral medical resources and the accessibility of health service capabilities in Wuhan. Methods The equity of oral medical resources was calculated with Gini coefficient and Theil index, accessibility was assessed by two-step floating catchment area model, and the spatial autocorrelation was used to study the high-low clustering of accessibility. Results The Gini coefficient of oral medical resources based on population level was around 0.3, and the Gini coefficient of oral medical resources based on geographic area was greater than 0.6. Theil index calculation results were similar. In terms of overall accessibility, the area with poor accessibility was 2,428 square kilometers, reaching 28.38% of the total area, while the area with better accessibility accounted for 14.18%. Conclusion The allocation of oral medical care resources based on population distribution was fairer and better than that based on geographic area. Moreover, the geographical accessibility varies greatly between regions, showing the characteristics of high-high cluster and low-low cluster.

Objective To observe the clinical efficacy ofXing Nao Kai Qiao(brain-awakening orifice-opening) needling method plus Frenkel's balance rehabilitation exercise in treating lower-limb dysfunction due to different types of ataxia after stroke.MethodA total of 115 eligible patients were randomized into two groups. Fifty-seven cases in the treatment group were intervened by Xing Nao Kai Qiaoneedling plus rehabilitation training; 58 cases in the control group were intervened byXing Nao Kai Qiaoneedling method alone. Berg Balance Scale (BBS) was adopted to evaluate the symptoms, balance function, and therapeutic efficacy before and after the treatment.Result In the treatment group, the markedly effective rate was respectively 72.2%, 83.3% and 61.1% in the cerebella subtype, brainstem subtype and basal ganglia subtype, and the total effectiverate was respectively 100.0%, 94.4% and 94.4%; in the control group, the markedly effective rate was respectively 21.1%, 35.0% and 58.8%, and the total effective rate was respectively 94.7%, 85.0% and 82.4%, and the between-group differences were statistically significant (P<0.05). After the treatment, the BBS score showed significant intra-group differences in both groups (P<0.01); the between-group comparisons showed that there were significant differences in comparing the scores of cerebella and brainstem subtypes after the treatment (P<0.05).ConclusionXing Nao Kai Qiaoneedling method plus Frenkel's rehabilitation exercise can effectively improve the symptoms of poststroke lower-limb ataxia, especially for cerebella and brainstem subtypes.

Objective To explore selective criteria of sphincter preservation operation(SPO) for middle to low third rectal cancer,and analyze clinicopathologic parameters resulting in the selective criteria.Methods Two hundred and seventy-nine cases of middle to low third rectal cancer who accepted operative treatment from 1996 to 2004 were analyzed retrospectively.One hundred and eighty-seven rectal tumours were located in 5-10 cm from anus,92 rectal tumours in below 5 cm from anus.Among them 127 cases were treated by abdominal-perineal resection(APR),and 152 cases were treated by SPO in which there were 130 Dixon operations,12 Bacon operations,and 10 Parks operations.Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically.Results Gender,age,size,tumor types,site of tumor,degree of differentiation,infiltrated circumference of intestine,and lymph node metastasis,depth of invasion and Dukes stages were not significantly different between APR and SPO groups.SPO performed rate was 54.48% in all.SPO was performed in 48 lower third rectal cancer cases(52.17%,48/92).Regional recurrence rate was 6.81%(19/279).Middle survival time was((65.00?6.87))months and 5-year survival rate was 63.51% in SPO group.Middle survival time was((52.23?5.63)) months and 5-year survival rate was 52.50% in APR group.Chi-Suqare was 18.14 by Log-rank test(P=0.054 1).Conclusion There is no statistically difference in survival rate between APR and SPO groups.

Objective To observe the clinical results of laparoscopic cholecystectomy(LC) combined with endoscopic Oddi sphincterotomy(EST) in treating cholecystolithiasis and choledocholithiasis.Methods The preoperative and postoperative clinical data of 20 cases that received LC & EST combined therapy for cholecystolithiasis and choledocholithiasis were analyzed retrospectively.Results The success rate was 95.0% ,with all the calculi removed completely;no complications occurred.The average hositpal stay was 7.5 days.Conclusions Combined LC & EST procedure is a safe and effective method to treat patients suffering from cholecystolithiasis and choledocholithiasis.