ObjectiveTo improve the quality standard of Yuanhu Zhitong oral liquid in order to strengthen the quality control of this oral liquid. MethodThin layer chromatography（TLC） was used for the qualitative identification of Corydalis Rhizoma and Angelicae Dahuricae Radix in Yuanhu Zhitong oral liquid by taking tetrahydropalmatine， corydaline reference substances and Corydalis Rhizoma reference medicinal materials as reference， and cyclohexane-trichloromethane-methanol（5∶3∶0.5） as developing solvent， Corydalis Rhizoma was identified using GF254 glass thin layer plate under ultraviolet light（365 nm）. And taking petroleum ether（60-90 ℃） -ether-formic acid（10∶10∶1） as developing solvent， Angelicae Dahuricae Radix was identified using a silica gel G TLC plate under ultraviolet light（305 nm）. High performance liquid chromatography（HPLC） was performed on a Waters XSelect HSS T3 column（4.6 mm×250 mm， 5 μm） with acetonitrile（A）-0.1% glacial acetic acid solution（adjusted pH to 6.1 by triethylamine）（B） as the mobile phase for gradient elution（0-10 min， 20%-30%A； 10-25 min， 30%-40%A； 25-40 min， 40%-50%A； 40-60 min， 50%-60%A）， the detection wavelength was set at 280 nm， then the fingerprint of Yuanhu Zhitong oral liquid was established， and the contents of tetrahydropalmatine and corydaline were determined. ResultIn the thin layer chromatograms， the corresponding spots of Yuanhu Zhitong oral liquid， the reference substances and reference medicinal materials were clear， with good separation and strong specificity. A total of 12 common peaks were identified in 10 batches of Yuanhu Zhitong oral liquid samples， and the peaks of berberine hydrochloride， dehydrocorydaline， glaucine， tetrahydropalmatine and corydaline. The similarities between the 10 batches of samples and the control fingerprint were all >0.90. The results of determination showed that the concentrations of corydaline and tetrahydropalmatine had good linearity with paek area in the range of 0.038 6-0.193 0， 0.034 0-0.170 0 g·L^-1， respectively. The methodological investigation was qualified， and the contents of corydaline and tetrahydropalmatine in 10 batches of Yuanhu Zhitong oral liquid samples were 0.077 5-0.142 9、0.126 1-0.178 2 g·L^-1， respectively. ConclusionThe established TLC， fingerprint and determination are simple， specific and reproducible， which can be used to improve the quality control standard of Yuanhu Zhitong oral liquid.

Continuing medical education for general practitioners is an important measure to upgrade the quality of primary health care services in China, which is still facing various challenges and need to be further developed and improved. This article analyzes the status quo and existing problems of continuing medical education for general practitioners in China, and proposes suggestions based on the concept of people centered and integrated health care (PCIC), including faculty development, training contents, assessment methods, and experience learning, to provide references for the improvement of continuing medical education for general practitioners.

Objective:To explore the application of COVID-19-specific IgG antibody in identifying epidemic Omicron BA.5 strain infection.Method:Omicron BF.7/BA.5 naturally infected population, healthy population vaccinated with the COVID-19 vaccine, and Omicron BF.7/BA.5 breakthrough cases were enrolled into this study. The serum WT-S-IgG and BA.5-S-IgG were detected by indirect ELISA, and the serum-specific IgG antibody levels of different populations were compared. The application value of the two antibody titers and the ratio of the two antibodies in identifying Omicron BA.5 epidemic strain infection were explored by the ROC curve, aiming to provide technical support for pathogen diagnosis.Results:The antibody titers of WT-S-IgG and BA.5-S-IgG in the breakthrough cases were higher than those in the naturally infected population and the healthy population ( P<0.05). The area under the curve (AUC) of WT-S-IgG and BA.5-S-IgG in identifying epidemic Omicron BA.5 strain infection was 0.947 and 0.961, respectively. The AUC of BA.5-S-IgG and WT-S-IgG antibody titer ratio was 0.873. When the antibody titer ratio was 0.855, the sensitivity and specificity were 80.00% and 90.00%, respectively. According to the interval since the last infection, the AUC of the ratio of BA.5-S-IgG to WT-S-IgG antibody titer to identify the infection of epidemic strains less than 30 days and more than 30 days was 0.887 and 0.863, respectively, and the sensitivity and specificity were both above 80%. Conclusion:Both BA.5-S-IgG and WT-S-IgG, as well as the combination of these two antibodies, are of high value in the identification of epidemic strains.

Multimorbidity management for the elderly is a big challenge for China′s healthcare system and the people centered integrated care (PCIC) is a new concept in health care reform, and the application of the PCIC in multimorbidity management can better improve the health servece for elderly patients. This article applies SWOT analysis to assess the internal strengths and weaknesses as well as external opportunities and threats of applying the PCIC to the geriatric management of multimorbidity; also proposes strategies of geriatric management for elderly patients with Chinese characteristics based on concept of PCIC. The proposed stretegies optimize the personalized assessment with the digital technology, promotes the management with close-knit healthcare system, and strengthen the role of primary medical institutions to improve the long-term management mechanism of multimorbidity.

Objective To retrospectively analyze of factors influencing early preterm birth(EPB)and late preterm birth(LPB)in pregnancy women with placenta previa complicated by placenta accreta spectrum disorders(PAS),and assess maternal and infant outcomes.Methods We included 590 cases of pregnancy women with placenta previa complicated by PAS who underwent cesarean sections at five hospitals in Wuhan and Xianning cities between January 2018 and June 2021.These patients were divided into three groups based on delivery gesta-tional age:EPB,LPB,and term birth(TB).A multiple logistic regression model was employed to analyze the risk factors associated with EPB and LPB.Additionally,differences in early maternal and infant outcomes among these groups were examined.Results Among 590 pregnancy women with placenta previa complicated by PAS,the proportions of EPB and LPB were 9.7%and 54.4%.The use of uterine contraction inhibitors prior to cesarean section,vaginal bleeding,and previous cesarean sections history were identified as risk factors for both EPB and LPB.The proportion of severe postpartum hemorrhage was comparable between the EPB group and the LPB group;however,the incidence of neonatal asphyxia,low birth weight infants,and the rate of newborns transferred to the Neonatal Intensive Care Unit(NICU)within 24 hours after cesarean delivery were significantly higher in the EPB group compared to the LPB group.Conclusions Placenta previa complicated by PAS predominantly leads to LPB.The history of prior cesarean sections,uterine contractions,and vaginal bleeding prior to cesarean section,are sig-nificantly associated with both EPB and LPB.During the perinatal period,efforts should be made to extend gesta-tional weeks under close monitoring to minimize the incidence of premature births and thereby improve early mater-nal and infant outcomes.

Objective:To explore the application of COVID-19-specific IgG antibody in identifying epidemic Omicron BA.5 strain infection.Method:Omicron BF.7/BA.5 naturally infected population, healthy population vaccinated with the COVID-19 vaccine, and Omicron BF.7/BA.5 breakthrough cases were enrolled into this study. The serum WT-S-IgG and BA.5-S-IgG were detected by indirect ELISA, and the serum-specific IgG antibody levels of different populations were compared. The application value of the two antibody titers and the ratio of the two antibodies in identifying Omicron BA.5 epidemic strain infection were explored by the ROC curve, aiming to provide technical support for pathogen diagnosis.Results:The antibody titers of WT-S-IgG and BA.5-S-IgG in the breakthrough cases were higher than those in the naturally infected population and the healthy population ( P<0.05). The area under the curve (AUC) of WT-S-IgG and BA.5-S-IgG in identifying epidemic Omicron BA.5 strain infection was 0.947 and 0.961, respectively. The AUC of BA.5-S-IgG and WT-S-IgG antibody titer ratio was 0.873. When the antibody titer ratio was 0.855, the sensitivity and specificity were 80.00% and 90.00%, respectively. According to the interval since the last infection, the AUC of the ratio of BA.5-S-IgG to WT-S-IgG antibody titer to identify the infection of epidemic strains less than 30 days and more than 30 days was 0.887 and 0.863, respectively, and the sensitivity and specificity were both above 80%. Conclusion:Both BA.5-S-IgG and WT-S-IgG, as well as the combination of these two antibodies, are of high value in the identification of epidemic strains.

Objective:To analyze the prognostic factors of children with septic shock in the pediatric intensive care unit.Methods:The clinical data of children diagnosed with septic shock in the pediatric intensive care unit of Guiyang Maternal and Child Health Hospital from April 2018 to April 2022 were retrospectively collected,and the children were divided into the death group and the survival group according to seven days regression.The basic data of the two groups were statistically compared，and the relationship between lactic acid，vasoactive-inotropic score one hour after admission，time of antibiotic initiation，serum potassium，serum sodium，serum calcium，serum troponin T，fluid resuscitation volume in the first hour，glutamyl aminotransferase，creatinine，total leukocyte count，C-reaction protein，brain natriuretic peptide were compared.The risk factors affecting the death of children were analyzed by Logistic regression.The relationship between fluid resuscitation volume in the first hour and prognosis was analyzed using the receiver operator characteristic (ROC) curve.Results:（1）A total of 67 children were included，19 died and 48 survived.（2）The first-hour liquid resuscitation dose in the survival group was lower than that in the death group，and the difference was statistically significant（ P<0.05）.（3）The ROC curve showed that the optimal cut-off of the first-hour liquid resuscitation dose was 25 mL/kg，with a sensitivity of 57.9% and a specificity of 72.9%.（4）In unifactorial analysis，lactic acid in the first hour of admission，early lactic acid after resuscitation，serum calcium，serum troponin T，alanine aminotransferase，combined septic encephalopathy，Glasgow coma score，and pediatric critical illness score were all risk factors for death in children within seven days（ P<0.05）.(5) Multivariate Logistic regression analysis showed that serum calcium（ OR=1.435， P=0.001）and lactic acid value after resuscitation（ OR=0.040， P=0.021）were independent risk factors for death in septic shock. Conclusion:The higher the total fluid resuscitation in the first hour，the higher the fatality rate.Serum calcium and early lactic acid after resuscitation are independent risk factors for death in children within seven days.

Objective:To investigate the effects of video-assisted anal fistula treatment (VAAFT) on stress indicators and anal function in patients with anal fistula.Methods:Ninety-nine patients with anal fistula who received treatment in Lishui City People's Hospital from March 2020 to February 2022 were included in this study. They were randomly divided into a control group ( n = 48, undergoing fistulotomy) and an observation group ( n = 51, undergoing VAAFT). Clinical efficacy and the levels of various indexes during the perioperative period were compared between the two groups. Anal function [anal maximal contraction pressure, anal canal rest pressure, anal longest contraction time, anal incontinence Wexner score], and the levels of serum stress indicators [norepinephrine (NE), β-endorphin (β-EP), nerve growth factor (NGF), substance P (SP), and cortisol (Cor)] were determined before and after treatment. Postoperative complications were recorded. All patients were followed up for 3 months after surgery. Recurrence of anal fistula was compared between the two groups. Results:The total effective rate in the observation group was 94.12% (48/51), which was significantly higher than 79.17% (38/48) in the control group ( χ2 = 4.84, P < 0.05). The operative time, intraoperative blood loss, wound healing time, and length of hospital stay in the observation group were (34.78 ± 4.01) minutes, (34.48 ± 3.86) mL, (19.46 ± 2.05) days, and (12.76 ± 1.50) days, which were significantly shorter or less than those in the control group [(54.86 ± 6.05) minutes, (36.88 ± 4.01) mL, (25.61 ± 2.92) days, (21.05 ± 2.46) days, t = -19.57, -3.03, -12.18, -20.67, all P < 0.05). On the first day after surgery, the Visual Analogue Scale score in the observation was (1.88 ± 0.28) points, which was significantly lower than (3.55 ± 0.41) points in the control group ( t = -23.78, P < 0.05). At 3 months after surgery, anal maximal contraction pressure and Wexner scores in the observation group were (171.86 ± 18.68) mmHg and (0.39 ± 0.07) points, which were significantly lower than (180.37 ± 19.56) mmHg and (0.52 ± 0.09) points in the control group ( t = -2.21, -8.04, both P < 0.05). Anal canal rest pressure in the observation group was (50.77 ± 5.68) mmHg, which was significantly higher than (48.34 ± 5.23) mmHg in the control group ( t = 2.21, P < 0.05). There was no significant difference in anal longest contraction time between the two groups before and after treatment (both P > 0.05). At 3 days after surgery, NE and Cor levels in each group increased compared with those before surgery (both P < 0.05). At 3 days after surgery, NE and Cor levels in the observation group were (252.67 ± 29.16) μg/L and (281.34 ± 31.27) nmol/L, respectively, which were significantly lower than (304.03 ± 32.28) μg/L and (308.72 ± 34.18) nmol/L in the control group ( t = -8.31, -4.16, both P < 0.05). At 3 days after surgery, β-EP, SP, and NGF in each group were decreased compared with those before treatment (all P < 0.05). At 3 days after surgery, β-EP, SP, and NGF in the observation group were (62.37 ± 6.83) ng/L, (1.87 ± 0.23) ng/L, (30.82 ± 4.03) mg/L], respectively, which were significantly higher than (51.09 ± 5.74) ng/L, (2.59 ± 0.51) ng/L, and (38.19 ± 4.24) mg/L in the control group ( t = 8.86, 8.95, 8.85, all P < 0.05). There was no significant difference in the incidence of complications between the two groups ( P > 0.05). The recurrence of anal fistula in the observation group was 1.96% (1/51), which was significantly lower than 12.50% (6/48) in the control group ( χ2 = 4.18, P < 0.05). Conclusion:VAAFT exhibits a significant therapeutic effect on anal fistula, with a small surgical incision and minimal intraoperative bleeding. This procedure greatly shortens operative time and the length of hospital stay, alleviates postoperative pain, improves anal function, reduces postoperative stress response indicators, and has a low postoperative recurrence rate.

The hemodynamics of children with congenital heart disease (CHD) often changes during the perioperative period. Unfortunately, the evaluation of cardiac function in children with CHD is mainly focused on the left ventricle. With the further understanding of cardiac hemodynamics, the monitoring of RV function has gradually become an important part of cardiac intensive care department. We totally searched five databases including Pubmed, Embase, Cochrane, Wanfang Med, as well as China National Knowledge Infrastructure (CNKI) and reviewed the clinical research progress of the application of TAPSE in the evaluation of RV systolic function in children with CHD to provide a theoretical basic for the monitoring of RV function before and after operation in children with CHD.

Objective:To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) with negative pressure suction sheath and PCNL with traditional expanded sheath in the treatment of infectious renal calculus.Methods:From May 2019 to June 2022 in our department, 35 patients with infectious renal calculus who received PCNL with negative pressure suction sheath (negative pressure sheath group, NPS group) and another 35 patients with infectious renal calculus who received PCNL with traditional expanded sheath (control group) were determined in our research. Propensity score matching (PSM) was conducted. Preoperative clinical data of the 2 groups was similar and there were no statistical differences between the 2 groups in the age [(45.5±6.8)vs. (44.9±7.3) years old, P=0.723], gender (man/woman 19/16 cases vs. 21/14 cases, P=0.629), body mass index(BMI) [(24.2±4.2)kg/m 2vs. (24.5±3.9)kg/m 2, P=0.758], American Society of Anesthesiologists risk score(ASA) (grade 1/grade 2: 30/5 cases vs. 29/6 cases, P=0.743), sides of calculus (left/right: 18/17 cases vs. left 17/18 cases, P=0.811), Guy’s stone score (grade Ⅰ/Ⅱ/Ⅲ: 3/25/7 cases vs. 1/29/5 cases, P=0.443), CT value of calculus [(629.2±98.8)HU vs. (608.5±105.1)HU, P=0.399], urinary leucocyte (-/+ /+ + : 29/5/1 cases vs. 28/5/2 cases, P=0.839), hypertension(3 cases vs. 5 cases, P=0.707), diabetes(2 cases vs. 2 cases, P=1.000). The ureteral catheter on the affected side was indwelled in the lithotomy position, and ultrasound guided positioning puncture was performed on the affected renal side of the posterior axillary line in the prone position. The puncture channel was established and then expanded to F20 successively, and the lithotriptic sheath was placed to establish the lithotriptic channel. Compared with the traditional expanded sheath, the negative pressure suction sheath was different in that the collateral suction channel was added on the main gravel channel and connected with continuous negative pressure suction. The negative pressure was 40 kPa. All patients were treated with pneumatic ballistic lithotripsy combined with holmium laser. KUB was performed within 1 week after surgery. We defined stone removal as either no residual stones or clinically insignificant residual stones (≤4 mm) which did not cause urinary obstruction. The intraoperative duration of operation and postoperative clinical parameters [white blood cell(WBC), procalcitonin(PCT), C-reactive protein(CRP), hemoglobin(Hb), stone clearance rate] and incidence of perioperative complications were compared between the 2 groups. Results:The operation time of NPS group was lower than that in control group [(35.6±19.5)min vs. (45.4±20.2)min, P<0.05]. The proportion of patients with increased WBC, PCT and CRP in blood after operation in NPS group was lower than that in control group, and there were (WBC: 25.7% vs. 54.3%, P<0.05), (PCT: 42.9% vs.68.6%, P<0.05) and (CRP: 62.9% vs.85.7%, P<0.05) respectively. There was no significant difference in the proportion of patients with decreased Hb postoperatively between the 2 groups (2.9% vs. 8.6%, P=0.607). There was no significant difference in calculus clearance rate postoperatively between the 2 groups (97.1% vs. 94.3%, P=1.000). Postoperative calculus component analysis of the 2 groups suggested that all patients had infected calculus dominated by ammonium magnesium phosphate and phosphate apatite. The incidence of perioperative complications in NPS group was lower than that in control group (22.9% vs. 51.4%, P<0.05). The proportion of patients with fever (body temperature>37.5℃) postoperatively in NPS group was lower than that in control group (14.3% vs. 37.1%, P<0.05). There were 2 and 3 patients respectively required upgraded antibiotic therapy after operation in the 2 groups ( P=1.000). There was one patient respectively with urinary tract obstruction and renal colic due to blood clots postoperatively in each group ( P=1.000). There was one patient with urinary sepsis in control group after operation ( P=0.476). Conclusions:Compared with PCNL with traditional expanded sheath, PCNL with negative pressure suction sheath can save operation time for infectious renal calculus, and reduce the incidence of postoperative infection and perioperative complications. Therefore, the safety of negative pressure suction sheath is higher. However, there is no difference in stone clearance rate between them.