Objective To study the latent classification of medical service utilization behaviors among middle-aged and older chronic disease patients,providing a theoretical basis for the allocation of medical resources.Methods Using data from the 2018 China Health and Retirement Longitudinal Study(CHARLS)database,latent class analysis was employed to conduct subgroup analysis on the medical choice preferences of middle-aged and older chronic disease patients.Logistic regression was used to analyze the influence of various factors on medical preference subgroups.Results The medical choice preferences of middle-aged and older chronic disease patients were classified into three latent subgroups:public hospital treatment preference type,non-public hospital treatment preference type,and public hospital consultation preference type.Compared to the public hospital treatment preference type,patients under 60 years old(OR=0.456,P=0.034),those living in rural areas(OR=0.256,P=0.006),and those with smoking habits(OR=3.11,P＜0.001)were more inclined to choose non-public hospitals for treatment.In contrast,patients over 60 years old(OR=1.916,P=0.015),those with an education level of primary school or above(OR=2.595,P=0.004),and those with smoking habits(OR=2.591,P=0.044)tended to choose public hospitals for consultation or physical examinations.Conclusion Currently,private hospitals play an increasingly prominent role in chronic disease treatment.However,the utilization rate of traditional Chinese medicine among middle-aged and older chronic disease pa-tients is relatively low,and health awareness remains weak.It is recommended to strengthen the regulation of private hospitals,enhance the credibility and accessibility of traditional Chinese medicine,and intensify health education in communities to meet the growing health demands of middle-aged and older chronic disease patients.

Objective To study the latent classification of medical service utilization behaviors among middle-aged and older chronic disease patients,providing a theoretical basis for the allocation of medical resources.Methods Using data from the 2018 China Health and Retirement Longitudinal Study(CHARLS)database,latent class analysis was employed to conduct subgroup analysis on the medical choice preferences of middle-aged and older chronic disease patients.Logistic regression was used to analyze the influence of various factors on medical preference subgroups.Results The medical choice preferences of middle-aged and older chronic disease patients were classified into three latent subgroups:public hospital treatment preference type,non-public hospital treatment preference type,and public hospital consultation preference type.Compared to the public hospital treatment preference type,patients under 60 years old(OR=0.456,P=0.034),those living in rural areas(OR=0.256,P=0.006),and those with smoking habits(OR=3.11,P＜0.001)were more inclined to choose non-public hospitals for treatment.In contrast,patients over 60 years old(OR=1.916,P=0.015),those with an education level of primary school or above(OR=2.595,P=0.004),and those with smoking habits(OR=2.591,P=0.044)tended to choose public hospitals for consultation or physical examinations.Conclusion Currently,private hospitals play an increasingly prominent role in chronic disease treatment.However,the utilization rate of traditional Chinese medicine among middle-aged and older chronic disease pa-tients is relatively low,and health awareness remains weak.It is recommended to strengthen the regulation of private hospitals,enhance the credibility and accessibility of traditional Chinese medicine,and intensify health education in communities to meet the growing health demands of middle-aged and older chronic disease patients.

Objective The literature on perioperative management of patients with spinal tuberculosis(STB)in China was analyzed.To provide ideas and directions for the perioperative management of patients with spinal tuberculosis.Methods The journal literature on"spinal tuberculosis"and"perioperative period"were retrieved from Chinese National Knowledge Infrastructure,VIP Chinese Journal Service Platform,China Biology Medicine Disc and Wanfang Data during the period from January 1,1990 to May 31,2023.The VOSviewer software was used to visually analyze the retrieved literature data.The analysis includes publication year,publication region,journal distribution,keywords and so on.Results A total of 1306 papers were included.The overall number of published papers showed a trend of first increasing and then decreasing.The journal with the largest number of publications was Chinese Journal of Tuberculosis,with 53 publications(4.06％).75 keywords with frequency≥8 times were analyzed to form a cluster graph,and a total of 6 clusters were found.The themes of clustering were operation mode and timing,elderly patients and children,perioperative nursing,recurrence risk factors,postoperative complications,rehabilitation and functional exercise.Conclusion Research on perioperative management of patients with STB in China showed an initial rise and then a slow decline.Future studies need to focus more on vulnerable populations.Combined with the concept of rapid rehabilitation,we can explore the effective management mode of patients with STB in perioperative period.Accelerate the postoperative rehabilitation of patients with STB.

Objective:To survey the status quo of clinical teaching by specialists in general practice residents training.Methods:Thirty-four general practice residents (14 males and 20 females, aged (27.9±1.8) years) who started standardized training in 2016, 2017 and 2019 in the First Affiliated Hospital of Zhejiang University School of Medicine were selected for interview. The semi-structured and open-ended telephone interviews were conducted 6 months after their completion of residency training. The 1st round of interviews with 12 residents of 2016 and 2017 batches was conducted in March 2020 and 2021 to understand their feelings and suggestions about specialty learning. Based on the interview results, literature review, expert consultation and internal discussion, a new model for specialty teaching was developed and applied for subsequent residency training. The second round of interviews was conducted with 22 residents of 2019 batch on March 2023 to investigate the implementation of the new model.Results:In the first round of interviews, 6 participants felt that the learning of specialty knowledge was not comprehensive enough; although all respondents said that they had received simulator training for the final exam in the specialty rotation, 2 people felt that it was not comprehensive and 2 mentioned that some of the items were not practised on a real person; all 12 respondents felt that there was a certain gap between the types of diseases they encountered in the specialty learning and the real world of work; 10 respondents mentioned that there was insufficient training in the management of chronic non-chronic diseases; 7 out of 9 respondents from primary care institutions mentioned that it was difficult to apply the learned specialty knowledge to real work due to local conditions; 7 respondents mentioned that the content and methods of teaching were inconsistent among different lecturers; and respondents hoped that the surgical training, physical exam training, medication instruction, and the length of outpatient follow-up consultations would be strengthened. In the second round of interviews, the feedback of respondents was more positive than in the first round, there were still problems with the separation of teaching and examination content, and insufficient practical training of skills; 2 respondents from general hospitals mentioned that the teaching of specialties should be further deepened, and 3 respondents from the primary care institutions mentioned that the teaching of treatment and follow-up management should be further strengthened. Twenty-one respondents generally accepted the new specialty teaching model, but said that there were big differences between teachers of different specialties and there were still problems such as insufficient guidance on drug treatment and follow-up.Conclusion:In general practice, residency training specialist teaching does not fully meet the requirements of the actual work of general practitioners, and although it has improved after optimization, there is still much room for improvement.

OBJECT IVE To provide reference for the improvement of the quality standard for Niushanggui capsules. METHODS Based on the previous quality standard ，thin-layer chromatography （TLC）identification methods were established for Angelicae dahurica and Anemarrhenae asphodeloides . High performance liquid chromatography （HPLC）method was established to determine the contents of 5 components simultaneously ，such as mangiferin ，prim-O-glucosylcimifugin，naringin，neohesperidin and 5-O-methylvisammioside. The limits were confirmed. RESULTS TLC chromatogram of Niushanggui capsules showed the same color spots in the same position as the corresponding （mixed）substance control or reference medicinal material of A. dahuricae and A. asphodeloides ，while the negative samples had no interference. The linear range of mangiferin ，prim-O-glucosylcimifugin， naringin，neohesperidin and 5-O-methylvisammioside were 7.98-127.63，6.74-107.84，53.06-848.96，39.31-628.90，13.54-216.62 μg/mL，respectively（all r＝0.999 9）. RSDs of precision ，stability（24 h）and repeatability tests were all no more than 1.20％（n＝ 6）. The average recoveries were 95.00％，105.16％，97.16％，101.00％ and 104.97％（RSD≤1.50％，n＝6）. In 4 batches of samples，the average contents of the above 5 components were 0.842，0.696，6.951，5.755 and 1.106 mg/g respectively ；the limits of A. asphodeloides ，Saposhnikovia divaricata and Citrus aurantium were based on the contents of mangiferin ，the total content of prim-O-glucosylcimmifugin and 5-O-methylvisammioside，naringin and neohesperidin ，which would not be less than 0.42，0.90 and 6.36 mg/grain，respectively. CONCLUSIONS TLC identification methods of A. dahurica and A. asphodeloides and the content determination methods of 5 components as mangiferin in Niushanggui capsules are established in this study ，and the limits of A. asphodeloides ，S. divaricata and C. aurantium are confirmed.

OBJECTIVE：To study industry-university-resear ch cooperation model and network evolution characteristics of pharmaceutical manufacturing industry in China ，and to provide decision-making basis for pharmaceutical innovation cooperation. METHODS：Using social network analysis method ，based on industry-university-research cooperation patent data of pharmaceutical manufacturing industry during 1998-2019，the patent cooperation network of pharmaceutical manufacturing industry in China was established，and the structural parameters were calculated and evolution regularity of the network were analyzed. RESULTS ： Industry-university-research cooperation patents in the pharmaceutical manufacturing industry were affected by drug innovation policies. The scale of innovation network in pharmaceutical manufacturing industry was expanding day by day ；the density of innovation network was decreasing gradually ；it was not characterized with typical small world features. CONCLUSIONS ：It is suggested to strengthen the scientific and technological support to the core innovation subjects （universities and research institutions），and improve the cooperation with enterprises ；optimize the drug innovation policy environment ，encourage more innovation subjects to participate in the drug R&D process ；construct a platform for industry-university-research collaborative innovation，build drug R&D mechanism which can promote industry-university-research cooperation ，reduce the number of intermediaries in cooperation ，optimize the allocation of drug R&D resources and promote cooperative innovation of enterprises.

Objective:To explore the effect of tibial nerve vibration on triceps surae spasticity in stroke survivors and its electrophysiological mechanism.Methods:Thirty stroke survivors with upper limb spasticity were randomly divided into a treatment group and a control group, each of 30. Both groups were given routine rehabilitation training while the treatment group was additionally provided with local vibration of the tibial nerve with an amplitude of 0.3mm at 60Hz. Before and after the treatment, the modified Ashworth scale (MAS) and Clonus grading were used to assess muscle tone and spasticity. Electrophysiological functions were evaluated using the tibial nerve motor and sensory conduction test and F wave and H reflex sensing.Results:Before the treatment there were no significant differences between the two groups in their average MAS scores, Clonus grading, maximum H amplitude (Hmax), the ratio of maximum H to maximum M amplitude (H/M) or the intensity of stimulus required to elicit Hmax. After the treatment, however, all of those measurements had improved significantly in both groups with the average improvements in the treatment group significantly greater than those in the control group.Conclusions:Local vibration of the tibial nerve combined with traditional rehabilitation is more effective than traditional rehabilitation alone in relieving triceps surae spasticity and reducing muscle tone after a stroke. The vibration seems to inhibit excitation of the reflex pathway.

Objective To evaluate the clinical value of thyroid cancer gene detection and its joint diagnos-tic model in early diagnosis of thyroid nodule. Methods Retrospective study was used to analyze 61 cases of thy-roid nodules. These cases were divided into benign nodules and malignant nodules according to the pathology out-comes. We evaluated the AUC,sensitivity and specificity of preoperative fine needle aspiration biopsy(FNAB), thyroid cancer gene detection and color ultrasonography feature in the early diagnosis of thyroid nodule through lo-gistic regression analysis and ROC working curve. Results Among the 61 patients with thyroid nodules,there were 31 cases of benign thyroid nodules and 30 cases of malignant nodules.Diagnostic indexes significantly related with thyroid nodules and their AUC were listed as following:cancer gene detection 0.915(95% CI:0.814-0.971), FNAB 0.813(95% CI:0.691-0.902),low echo 0.657(95% CI:0.523-0.775),size of nodules 0.623(95% CI:0.488-0.745),joint diagnostic model respectively 0.957(95%CI:0.871-0.993). The value of joint diagnosis was the highest,whose sensitivity was 93.1% and the specificity was 90.3%.Conclusion Preoperative cancer gene de-tection joint FNAB and color ultra-sonography will improve the detection rate of thyroid cancer and reduce unneces-sary operation.

OBJECTIVETo assess the value of 15 short tandem repeat (STR) loci selected by an AmpFLSTR Identifilersystem for personal identification and paternity testing among ethnic Hans from Xiamen, Fujian.

METHODSFor 400 unrelated individuals, allelic frequencies for the 15 STR loci from the AmpFLSTR Identifilerkit were determined. Population genetics parameters for forensic usage were calculated.

RESULTSNo deviation of the observed allele frequency from Hardy-Weinberg equilibrium expectations was found by Chi-square test (P>0.05). All of the 15 loci were highly polymorphic. Observed heterozygosity has varied between 0.580 and 0.868. Matching probability was between 0.036 and 0.148. Power of discrimination was between 0.798 and 0.967. Polymorphic information content was between 0.560 and 0.850. And power of exclusion was between 0.268 and 0.730.

CONCLUSIONAll of the 15 loci selected by the AmpFLSTR Identifilersystem are highly polymorphic among ethnic Hans from Xiamen. By determining the alleles and allelic frequencies, data for genetic polymorphisms usable for paternity testing and personal identification for local population were obtained.

Alleles ; Asian Continental Ancestry Group ; genetics ; Chi-Square Distribution ; China ; Forensic Genetics ; methods ; Gene Frequency ; Genetics, Population ; methods ; Genotype ; Humans ; Linkage Disequilibrium ; Microsatellite Repeats ; genetics ; Polymorphism, Genetic

Objective To study the effects of acute coronary comprehensive syndrome with PCI therapy after secondary HIT-Ⅱ give sulphur of liver fondaparinux therapy clinical comprehensive effect.MethodsDecimation in 66 patients with acute coronary syndrome after PCI patients was applied on the basis of drug therapy and postoperative anticoagulation.Study group (33 cases) in the postoperative secondary HIT Ⅱ after being diagnosed with stop heparin and give sulphur of fondaparinux, bleeding in the coagulation indexes, within 30 days event and 6months heart vascular pieces efficacy evaluation.ResultsThe use of heparin before.The index of blood coagulation in study group were normal, confirmed HIT Ⅱ when the index change significantly (P<0.05) and the discontinuation of heparin 24h, 3d, 7d indexes compared at diagnosis were restored (P<0.05) and 14 days of heparin to stop with the use of heparin levels.The patients in the study group, the incidence of bleeding events was 9.1%, compared to 15.2% in the control group no significant difference.The patients in the study group of adverse cardiovascular events occurred rate was 12.1%, compared to 18.2% in the control group no significant difference.ConclusionAcute coronary syndrome after PCI HIT-Ⅱ to grant the sulphur of fondaparinux treatment had no significant effect on blood coagulation function and safety.