OBJECTIVE To observe the expressions of microribonucleic acid(miR)-155,miR-141,interleukin(IL)-22 and IL-17 in peripheral blood of the chronic renal failure(CRF)and hemodialysis(HD)patients compli-cated with hospital-associated infections and analyze the clinical treatment outcomes.METHODS A total of 561 CRF patients who underwent HD in Wuhan First Hospital from Jun.2022 to Jun.2023 were enrolled in the study and were divided into the infection group with 182 cases and the non-infection group with 379 cases according to the status of hospital-associated infections.The patients of the infection group were divided into the survival group with 138 cases and the death group with 44 cases according to the clinical therapeutic outcomes of a 6-month fol-low-up.The distribution of pathogens isolated from the CRF HD patients with hospital-associated infections was analyzed,the clinical data were compared between the infection group and the non-infection group;the levels of serum miR-155,miR-141,IL-22 and IL-17 were observed and compared among the groups.The values of the se-rologic markers in prediction of the clinical therapeutic outcomes of the CRF HD patients with hospital-associat-ed infections were analyzed by receiver operating characteristic(ROC)curves.RESULTS The proportions of pa-tients with no less than 1 year of hemodialysis,femoral venous catheter indwelling and long-term catheter indwell-ing were higher in the infection group than those in the non-infection group(P＜0.05).Totally 202 strains of pathogens were isolated from the infection group,125(61.88％)of which were gram-negative bacteria.There were significant differences in the levels of serum miR-155,miR-141,IL-22 and IL-17 between the infection group and the no infection group(P＜0.05),the biomarker with the greatest difference value was miR-141(t=37.145,P＜0.001).As compared with the patients with different therapeutic outcomes in the infection group,there were significant differences in the levels of serum miR-155,miR-141,IL-22 and IL-17 between the survival group and the death group(P＜0.05),and the index with the greatest difference value was IL-17(t=35.848,P＜0.001).The values of the four markers in prediction of the therapeutic outcomes of the CRF HD patients compli-cated with hospital-associated infections were analyzed by ROC curves,and the area under the curve(AUC)of the joint detection 0.922 was the highest(P＜0.05).CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the CRF HD patients complicated with hospital-associated infections.The levels of se-rum miR-155,miR-141,IL-22 and IL-17 are elevated with the incidence of infections and deterioration of progno-sis.The joint detection of the markers has high predictive value.

OBJECTIVE To observe the expressions of microribonucleic acid(miR)-155,miR-141,interleukin(IL)-22 and IL-17 in peripheral blood of the chronic renal failure(CRF)and hemodialysis(HD)patients compli-cated with hospital-associated infections and analyze the clinical treatment outcomes.METHODS A total of 561 CRF patients who underwent HD in Wuhan First Hospital from Jun.2022 to Jun.2023 were enrolled in the study and were divided into the infection group with 182 cases and the non-infection group with 379 cases according to the status of hospital-associated infections.The patients of the infection group were divided into the survival group with 138 cases and the death group with 44 cases according to the clinical therapeutic outcomes of a 6-month fol-low-up.The distribution of pathogens isolated from the CRF HD patients with hospital-associated infections was analyzed,the clinical data were compared between the infection group and the non-infection group;the levels of serum miR-155,miR-141,IL-22 and IL-17 were observed and compared among the groups.The values of the se-rologic markers in prediction of the clinical therapeutic outcomes of the CRF HD patients with hospital-associat-ed infections were analyzed by receiver operating characteristic(ROC)curves.RESULTS The proportions of pa-tients with no less than 1 year of hemodialysis,femoral venous catheter indwelling and long-term catheter indwell-ing were higher in the infection group than those in the non-infection group(P＜0.05).Totally 202 strains of pathogens were isolated from the infection group,125(61.88％)of which were gram-negative bacteria.There were significant differences in the levels of serum miR-155,miR-141,IL-22 and IL-17 between the infection group and the no infection group(P＜0.05),the biomarker with the greatest difference value was miR-141(t=37.145,P＜0.001).As compared with the patients with different therapeutic outcomes in the infection group,there were significant differences in the levels of serum miR-155,miR-141,IL-22 and IL-17 between the survival group and the death group(P＜0.05),and the index with the greatest difference value was IL-17(t=35.848,P＜0.001).The values of the four markers in prediction of the therapeutic outcomes of the CRF HD patients compli-cated with hospital-associated infections were analyzed by ROC curves,and the area under the curve(AUC)of the joint detection 0.922 was the highest(P＜0.05).CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the CRF HD patients complicated with hospital-associated infections.The levels of se-rum miR-155,miR-141,IL-22 and IL-17 are elevated with the incidence of infections and deterioration of progno-sis.The joint detection of the markers has high predictive value.

Macrophage polarization is involved in the entire process of the occurrence and development of knee osteoarthritis(KO A).By polarizing into distinct functional phenotypes,macrophages play key regulatory roles in the initiation of inflammation,matrix degradation,suppression of cartilage formation,and progression of the disease.The M1-type macrophages secrete numerous pro-inflammatory cytokines to exacerbate the inflammatory responses and promote the destruction of articular cartilage.Conversely,the M2-type macrophages help maintain the extracellular matrix homeostasis and facilitate cartilage formation by releasing anti-inflammatory factors while suppressing the secretion of inflammatory factors,thereby exerting anti-inflammatory effects and promoting tissue repair.Recent studies have shown that an imbalanced ratio of M1/M2 macrophages(M1/M2 ratio)is closely linked with both the pathogenesis and progression of KO A.Restoration of the dynamic balance between these two subtypes could be an essential strategy for treating and preventing KO A.This article reviewed the current literatures retrieved from PubMed and CNKI databases using the keywords"knee osteoarthritis"and"macrophages"over the past decade.The review introduced the process of macrophage polarization and the mechanisms of different macrophage phenotypes in KOA,and further discussed the recent advances in modulating the M1/M2 ratio for KOA management through chemical drugs,bioactive molecules,and traditional Chinese medicine and so on,aiming to provide the theoretical insights for future research and clinical interventions.

Objective By population survey,to explore the epidemiological characteristics of gastric precancerous lesions in Lishui District of Nanjing and provide objective basis for the prevention and treatment of early gastric cancer.Methods From July 2021 to December 2022,21 977 patients who received endoscopy and/or 13C-UBT in Lishui District People's Hospital and 6 medical community units in Nanjing City were retrospectively analyzed for demography characteristics,detection rate of gastric precancerous lesions,and H.Pylori infection rate.Results(1)590 cases of gastric precancerous lesions were detected(detection rate 2.68%);(2)The total detection rate of precancerous lesions and three pathological types in males were all higher than those in females(all P<0.001);(3)The minimum age for the total detection rate of precancerous lesions in males and the mini-mum age for each pathological type were lower than in females(P<0.001,0.009,0.005,0.002);(4)The popu-lation total H.pylori infection rate was 23.10%,the H.pylori infection rate in patients with precancerous lesions was higher than that in non-precancerous lesions(P<0.001),both H.pylori infection rate of male and female in precancerous lesions were all higher than those of non-precancerous lesions of the same sex(all P<0.001),in addition,the H.pylori infection rate of male whether in precancerous or non-precancerous lesions was higher than that of female(all P<0.001);(5)The precancerous lesions detection rate in male,female,and the overall age range of 20～29 to 70～79 years is positively correlated with age growth(P<0.001),and rapidly decreases after the age of 79,the of H.pylori infection rate was also positively correlated with age growth(P<0.001),and the trend of age change(P<0.001)was parallel to the precancerous lesions detection rate.Conclusions The detec-tion rate of gastric precancerous lesions in this region is above the average level in China;the total H.pylori infec-tion rate is at a relatively low level in China;the H.pylori infection rate is parallel to the age trend of the detection rate of gastric precancerous lesions,and increases with age.

Deterministic method is a numerical calculation method based on photon-electron coupled transport with high computational accuracy and speed, which has been widely applied in photon radiotherapy dose calculation in recent years. However, this method has been introduced into radiotherapy for only a short period of time, which has been rarely studied in China, and systematic understanding of its characteristics is still lacking. In this article, the principles of deterministic method, current development state and clinical application were reviewed, aiming to provide reference for carrying out relevant research.

Objective:To explore the changes of estrogen, androgen and progesterone in serum of male patients with primary gouty arthritis (pGA) and their possible role in the pathogenesis of gout.Methods:The serum, clinical data and laboratory parameters of 266 patients with PGA [including 93 patients with acute gout (AG), 118 patients with intermittent gout (IG), 55 patients with chronic gout (CG)] and 129 healthy controls (HC) were collected. The serum estradiol (E 2), progesterone (P), testosterone (T) and E 2/T were detected by CMIA Expression level. SPSS 17.0 statistical software was used for analysis, Wilcoxon rank sum test was used for comparison of measurement data between groups, and Spearman correlation analysis was used for correlation analysis between variables. Results:① The level of E 2 and T level in the serum of PGA, AG, IG and CG group was lower than that of the HC group [(30±8) pg/ml, (27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml, (35±10) pg/ml; F=17.770, P<0.05] and [(4.4±1.6) ng/ml, (3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml, (5.8±1.9) ng/ml; F=23.314, P<0.05], but there was no significant difference between HC group and CG group ( P>0.05), The serum E 2 and T levels in AG group were lower than those in IG and CG groups [(27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05] and [(3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml; F=23.314, P<0.05], andthe serum E 2 level in IG group was lower than that in CG group [(31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05). The levels of P and E 2/T in HC group were lower than those in pGA and AG group [(0.24±0.10) ng/ml, (0.27±0.11)ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05] and [(0.006 6±0.002 2) ng/ml, (0.007 6±0.003 2) ng/ml, (0.008 0±0.003 8) ng/ml; F=3.787, P<0.05), while those in IG and CG group were lower than those in AG group [(0.25±0.09) ng/ml, (0.26±0.08) ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05]; ② Spearman correlation analysis showed that E 2 level in pGA group was positively correlated with T and CysC( r=0.310, P<0.01; r=0.164, P=0.008), negatively correlated with MO ( r=-0.133, P=0.030), P level was positively correlated with MO ( r=0.139, P=0.023), T level was positively correlated with Crea and CysC ( r=0.179, P=0.003; r=0.162, P=0.008), negatively correlated with WBC, GR and MO ( r=-0.140, P=0.022; r=-0.173, P=0.005; r=-0.149, P=0.015), E 2/T was positively correlated with apob1 and Glu ( r=0.131, P=0.032; r=0.140, P=0.023). In AG group, E 2 level was positively correlated with T and Crea ( r=0.234, P=0.024; r=0.245, P=0.018), T level was positively correlated with Crea ( r=0.349, P=0.001), and negatively correlated with apob1 ( r=-0.250, P=0.016), and E 2/T was positively correlated with apob1 ( r=0.276, P=0.007). In IG group, E 2 level was positively correlated with T ( r=0.269, P=0.003), and negatively correlated with MO ( r=-0.183, P=0.048), while P level was positively correlated with MO( r=0.204, P=0.027). Conclusion:The expression of E 2 and T in the peripheral blood serum of gout patients decreases significantly, the expression of P and E 2/T increases significantly, and there is a positive correlation between E 2 and T, as well as the inflammatory and glycolipid metabolism indexes of gout patients, suggesting that estrogen, androgen and progesterone may participate in the pathogenesis of gout by regulating the inflammation and metabolism of gout.

Objective:To evaluate the safety and effectiveness of The Stork OTC conception aid kit for the treatment of male infertility compared with natural sexual intercourse.Methods:A multi-center, prospective, open, self-controlled, randomly crossed trial was performed in 57 infertility couples who were unable to naturally conceive, and were selected in Shanghai General Hospital, Shanghai Jiao Tong University, Reproductive Medicine Center,Tongji Medical College, Huazhong University of Science and Technology and Anhui Provincial Hospital from July 2017 to September 2018. Patients were required to participate both the conception aid kit and natural sexual intercourse in two consecutive periods of ovulation. A random envelope method was used to determine the application sequences of two methods. Twenty-nine couples were treated with the conception aid kit in the first month of ovulation, and applied the natural sexual intercourse in the second month of ovulation as group A. Twenty-eight couples were applied the natural sexual intercourse in the first month of ovulation, and were treated with the conception aid kit in the second month of ovulation as group B. Test results collected from all couples who used the conception aid kit were categorized as the test group data. Meanwhile, test results out of those couples who completed natural sexual intercourse were collected as control group data. Compared with its self-controlled natural sexual intercourse two months before and after, the effectiveness and safety of the conception aid kit was verified by general vaginal examination, routine leucorrhea examination, motile sperm score from post coital test (PCT), pregnancy rate comparison and other methods.Results:The trial was conducted at three clinical trial centers. A total of 57 infertility couples were enrolled. A total of 54 couples were validated eventually including 26 couples in group A and 28 infertility couples in group B. Effectiveness was evaluated. The PCT results showed that the sperm score of test group was 6.11±3.00, and the score of the sperm score of control group was 1.22±0.79. The motile sperm score of test group was 5 times ( P<0.001) than that in control group. In the follow-up, 7 (13.0%) of the couples successfully achieved pregnancy with the conception aid kit, 6 (85.7%) of them had healthy offspring, 1 (14.3%) had spontaneous abortion. No couples were pregnant after natural sexual intercourse. Safety was evaluated. The general examination of the vagina and the routine tests of the vaginal leukorrhea showed no difference between test group and control group. All 54 effective couples who completed the test can successfully use the conception aid kid to place the seminal vesicles containing semen and remove them with the attached pulling thread on time without obvious discomfort. Conclusion:The Stork OTC conception aid kits can effectively treat infertility, significantly increase the number of forward-moving sperm entering the cervix, and significantly increase the pregnancy rate. It is safe, non-invasive, simple, can be easily operate by patients themselves, and meets the needs of clinical applications.

Objective:To evaluate the safety and effectiveness of The Stork OTC conception aid kit for the treatment of male infertility compared with natural sexual intercourse.Methods:A multi-center, prospective, open, self-controlled, randomly crossed trial was performed in 57 infertility couples who were unable to naturally conceive, and were selected in Shanghai General Hospital, Shanghai Jiao Tong University, Reproductive Medicine Center,Tongji Medical College, Huazhong University of Science and Technology and Anhui Provincial Hospital from July 2017 to September 2018. Patients were required to participate both the conception aid kit and natural sexual intercourse in two consecutive periods of ovulation. A random envelope method was used to determine the application sequences of two methods. Twenty-nine couples were treated with the conception aid kit in the first month of ovulation, and applied the natural sexual intercourse in the second month of ovulation as group A. Twenty-eight couples were applied the natural sexual intercourse in the first month of ovulation, and were treated with the conception aid kit in the second month of ovulation as group B. Test results collected from all couples who used the conception aid kit were categorized as the test group data. Meanwhile, test results out of those couples who completed natural sexual intercourse were collected as control group data. Compared with its self-controlled natural sexual intercourse two months before and after, the effectiveness and safety of the conception aid kit was verified by general vaginal examination, routine leucorrhea examination, motile sperm score from post coital test (PCT), pregnancy rate comparison and other methods.Results:The trial was conducted at three clinical trial centers. A total of 57 infertility couples were enrolled. A total of 54 couples were validated eventually including 26 couples in group A and 28 infertility couples in group B. Effectiveness was evaluated. The PCT results showed that the sperm score of test group was 6.11±3.00, and the score of the sperm score of control group was 1.22±0.79. The motile sperm score of test group was 5 times ( P<0.001) than that in control group. In the follow-up, 7 (13.0%) of the couples successfully achieved pregnancy with the conception aid kit, 6 (85.7%) of them had healthy offspring, 1 (14.3%) had spontaneous abortion. No couples were pregnant after natural sexual intercourse. Safety was evaluated. The general examination of the vagina and the routine tests of the vaginal leukorrhea showed no difference between test group and control group. All 54 effective couples who completed the test can successfully use the conception aid kid to place the seminal vesicles containing semen and remove them with the attached pulling thread on time without obvious discomfort. Conclusion:The Stork OTC conception aid kits can effectively treat infertility, significantly increase the number of forward-moving sperm entering the cervix, and significantly increase the pregnancy rate. It is safe, non-invasive, simple, can be easily operate by patients themselves, and meets the needs of clinical applications.

Beginning with an introduction to overseas practices of privilege management, this paper analyzed the current privilege management of medical qualifications in China. On such basis, the authors introduced their insights and specific recommendations for the design and implementation of such management in China. These include: a platform for privilege management, a classified catalogue for medical qualifications, a procedure for the application, approval, examination and dynamic management of the qualifications, and an informatization platform for privilege management.

OBJECTIVE:To explore the cultivation method for community pharmaceutical care talents in higher vocational colleg-es. METHODS:According to the talent training aims to meet the demand of community pharmaceutical service positions in higher vo-cational colleges,the teaching reform was carried out for talent cultivation mode,course structure system,training base construction and teaching methods. RESULTS:In terms of talent cultivation mode,the work-integrated learning mode was built;in terms of course structure system,“Medicine,Pharmacy,Humanities and Expansion”course module was constructed to further optimize it;in terms of training base construction,the capital investment was increased to improve the school training base,meanwhile,cooperation between schools and enterprises was carried out to strengthen the construction of out-of-school training bases;in terms of teaching methods, PBL,case teaching model and situational teaching method were implemented. CONCLUSIONS:The quality of pharmaceutical talents has been significantly improved by implementing reform of the talent cultivation mode,the course structure system and teaching meth-ods,together with constructing training bases.