As the key of colleges and universities and medical career,the affiliated hospital's clinical department is the core of its development.In the new era,strengthening the mechanism of party branch participating in the decision-making of clin-ical departments is an inevitable requirement for implementing the party's leadership and strengthening hospital management.The Party branch of the affiliated hospital of the university has the"dual"attribute,through the establishment of the"core group"of the party branch to participate in decision-making in the clinical business department,the establishment of an efficient decision-making platform,the construction mechanism of supporting rules of procedure and supervision measures to realize its function,the in-depth analysis of management challenges and the improvement of countermeasures,in order to create a new way and a new mechanism of the party branch decision-making,and promote the deep integration of party building and business.

【Objective】 To establish an information management platform for provincial rare blood group bank to achieve the interconnection and sharing of data such as rare blood group types, donor information and blood inventory, so as to enhance the supply security of rare blood group blood. 【Methods】 The information barriers of rare blood group management in each business link and among blood stations in Zhejiang province were analyzed using fishbone diagram. Data modeling technology was introduced based on the unified blood collection and supply business system and blood cloud platform of Zhejiang, the database view of rare blood group donors and rare blood group was constructed through demand analysis and model design, and a unified query platform was developed to achieve the sharing of rare blood group information. 【Results】 The system integrated, retrievaled and displayed rare blood type information, achieving the interconnection of information among various business links and blood stations within blood banks. Up to now, in addition to RhD negative blood group, there were 8 types of rare red blood cells in the bank, covering 7 blood group systems, 289 rare blood group donors and 216 units of frozen red blood cells of rare blood group. 【Conclusion】 The information system based on data modeling can improve the overall efficiency and collaboration of the system, and reduce the workload of system development and operation. It can provide reference for standardized data management and application, and also provide a model for establishing and improving of a national rare blood group information network.

In clinical dentistry,addressing unique conditions such as tilted,elongated,and torsion teeth during prepa-ration can be effectively managed through digital tooth morphology design.The production of a multi-stage 3D-printed guide offered a more efficient and accurate solution.This article presented a case of significant inclination,elongation,and torsion in the maxillary and mandibular canines that were successfully treated using crown restoration modification.A crown preparation guide was fabricated based on the final form design of the restoration using the target restorative space analysis technique to ensure precise tooth preparation.A tooth preparation guide was also designed and utilized fur-ther to enhance accuracy and efficiency during complex tooth preparation.The combined application of these multi-stage guides demonstrated promising clinical prospects.

BACKGROUND: Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control. METHODS: The study was designed as a multicenter, open-label, randomized controlled trial. Eligible patients who were taking tofacitinib (5 mg twice daily) and had achieved sustained RA remission or low disease activity (disease activity score in 28 joints [DAS28] ≤3.2) for at least 3 months were enrolled at six centers in Shanghai, China. Patients were randomly assigned (1:1:1) to one of three treatment groups: continuation of tofacitinib (5 mg twice daily); reduction in tofacitinib dose (5 mg daily); and withdrawal of tofacitinib. Efficacy and safety were assessed up to 6 months. RESULTS: Overall, 122 eligible patients were enrolled, with 41 in the continuation group, 42 in the dose-reduction group, and 39 in the withdrawal group. After 6 months, the percentage of patients with a DAS28-erythrocyte sedimentation rate (ESR) of <3.2 was significantly lower in the withdrawal group than that in the reduction and continuation groups (20.5%, 64.3%, and 95.1%, respectively; P  < 0.0001 for both comparisons). The average flare-free time was 5.8 months for the continuation group, 4.7 months for the dose reduction group, and 2.4 months for the withdrawal group. CONCLUSION: Withdrawal of tofacitinib in patients with RA with stable disease control resulted in a rapid and significant loss of efficacy, while standard or reduced doses of tofacitinib maintained a favorable state. TRIAL REGISTRATION Chictr.org, ChiCTR2000039799.
Humans ; Quality of Life ; China ; Arthritis, Rheumatoid/drug therapy* ; Piperidines/therapeutic use* ; Treatment Outcome ; Antirheumatic Agents/therapeutic use* ; Pyrroles/therapeutic use*

Objective:To evaluate and summarize the evidence on the prevention and management of enteral nutrition interruption in critically ill children, to provide evidence-based basis for guiding the prevention and management of enteral nutrition interruption.Methods:All the evidence on prevention and management of enteral nutrition interruption in critically ill children, including guidelines, evidence summaries, systematic reviews, best practice information books, clinical decision-making, recommended practices, expert consensus and original research was searched in the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center Database, British Medical Journal Best Practice, UpToDate, National Institute for Health and Care Excellence, New Zealand Guideline Group, Guidelines International Network, Scottish Intercollegiate Guideline Network, Registered Nurses' Association of Ontario, Australian Clinical Practice Guidelines, Medlive, American Society for Parenteral and Enteral Nutrition, American Society of Critical Care Medicine, European Society of Intensive Care Medicine, European Society for Clinical Nutrition and Metabolism, Malnutrition and Nutritional Care in the UK, Chinese Medical Association, CINAHL, Cochrane Library, PubMed, Web of Science, Embase, China Biology Medicine disc, WanFang Data, CNKI, and VIP. The retrieval period was from the establishment of the database to May 27, 2022.Results:A total of 26 articles were included, including 2 guidelines, 2 expert consensuses, 1 systematic review, 4 randomized controlled trials, 3 quasi experimental studies, 6 cohort studies, 3 case-control studies, 4 cross-sectional surveys and 1 case series. 20 pieces of evidence in 5 categories including definition, status, harms, predictors, prevention and management of enteral nutrition interruption were summarized .Conclusions:The evidence summary process is scientific, rigorous, and comprehensive in content. Medical and nursing staff should choose the best evidence based on specific situations and individual patient's factors during the evidence conversion process, to prevent and manage enteral nutrition interruption in critically ill children, and improve their clinical outcomes.

OBJECTIVES: Recently, the use of biological synthesis of metal nanoparticles has attracted widespread attention. Researchers are trying to find a biological method to synthesize silver nanoparticles with little environmental pollution and easy preparation, and to explore the impact of preparation conditions on the synthesis of silver nanoparticles. This study aims to explore the biological synthesis of silver nanoparticles (AgNPs) with controllable size and good effect and to compare their biological activity with that of AgNPs prepared by chemical method. METHODS: In this study, AgNPs were prepared by biological method with water extract of Tricholomagambosum (WET) and cell-free supernatant of Lactobacillus crispatus (CFS) as reducing agent and protective agent, and silver nitrate solution as precursor. Meanwhile, AgNPs was synthesized by sodium citrate chemical method. The effects of temperature, pH, dosage of extraction solution and light conditions on the biosynthesis of WET-AgNPs and CFS-AgNPs were investigated, and their characteristic of the synthesized WET-AgNPs and CFS-AgNPs were analyzed. Finally, the antibacterial effect, toxicity and selectivity of the 3 different AgNPs were compared. RESULTS: AgNPs were synthesized successfully by the 3 methods with various characteristics. The AgNPs prepared by biological method (WET-AgNPs , CFS-AgNPs) were greatly affected by pH and temperature. The WET-AgNPs and CFS-AgNPs prepared by the biological methods had better antibacterial effect than the AgNPs by the chemical method (all P<0.01). Between them, the WET-AgNPs had a slightly higher antibacterial effect than the CFS-AgNPs. Compared with the AgNPs prepared by chemical method, the toxicity of the WET-AgNPs and CFS-AgNPs to normal cells was lower (both P<0.01), and the cell selectivity of the CFS-AgNPs was better when the concentration was 480 μg/mL. CONCLUSIONS AgNPs with biological activity can be synthesized from WET and CFS, which have different biological activity compared with the AgNPs prepared by biological method.
Humans ; Metal Nanoparticles ; Fatigue Syndrome, Chronic ; Silver/pharmacology* ; Anti-Bacterial Agents/pharmacology* ; Plant Extracts/pharmacology*

Objective:To investigate the status quo of decision-making fatigue of parents of critically ill children and analyze its influencing factors, so as to provide a theoretical basis for reducing the degree of decision-making fatigue of parents of critically ill children.Methods:Using the convenient sampling method, parents of 310 critically ill children who were treated in 3 Class Ⅲ Grade A hospitals in Henan Province were selected as the research objects from April 2020 to April 2021. The General Information Questionnaire, the Chinese version of Decision-making Fatigue Scale, Self-Control Scale and the Chinese version of Willpower Belief Measurement Questionnaire were used to conduct a questionnaire survey. Univariate and multiple linear regression analysis were used to analyze the influencing factors of decision-making fatigue in parents of critically ill children. A total of 310 questionnaires were distributed in this study and 302 valid questionnaires were recovered, with an effective recovery rate of 97.42%.Results:The total score of decision-making fatigue of parents of 302 critically ill children was (9.13±1.73) , the total score of self-control was (53.41±7.29) and the total score of willpower belief was (22.67±3.64) . The results of multiple linear regression analysis showed that the relationship with the children, the length of ICU stay, the monthly family income, the presence or absence of sleep disorders, parental self-control and parental willpower beliefs were the influencing factors of decision-making fatigue in parents of critically ill children ( P<0.05) . Conclusions:The decision-making fatigue level of parents of critically ill children is at a moderately low level, which is affected by a variety of factors. Medical workers should intervene according to specific circumstances to reduce the decision-making fatigue of parents of critically ill children and maximize the interests of the children.

Objective:To investigate the clinical manifestations, laboratory and imaging features, treatment and prognosis of systemic lupus erythematosus (SLE) with primary sclerosing cholangitis (PSC).Methods:This is a retrospective case series study describing the clinical, laboratory and imaging manife-stations, treatment and prognosis of 3 SLE patients with PSC. The related literatures were reviewed.Results:In total, 10 patients were included. SLE with PSC, with an average age of (43±17) years old, was more common with hematological and renal involvement, jaundice and arthralgia, positive anti-double-stranded DNA (anti-dsDNA) antibody, hypocomplementemia, elevated erythrocyte sedimentation rate (ESR) and abnormal liver function with predominately elevated alkaline phosphatase (ALP). The classic magnetic resonance cholangio-pancreatography (MRCP) features of PSC include multifocal strictures, beading and areas of dilatation involving the intra- and/or extrahepatic bile ducts. The treatment included glucocorticosteroids, immunosup-pressants and ursodeoxycholic acid (UDCA), and some patients required biliary drainage. Most patients had a good prognosis.Conclusion:Although PSC is rare, attention should be paid to SLE patients with abnormal liver function, especially with elevated ALP, in order to differentiate from PSC.

【Objective】 To continuously improve the management of blood donors and ensure blood safety in the Yangtze River Delta(Zhejiang province, Jiangsu province, Anhui province and Shanghai city). 【Methods】 The information sharing system for donation interval query in the Yangtze River Delta was established in July 2020 to provide data and technical support to block blood donors who should not redonate due to insufficient intervals. 【Results】 Blood stations in the Yangtze River Delta unified the information sharing standard, developed the query service and realized the information sharing of donation interval query. 【Conclusion】 The establishment of this system could reduce the risk of blood donation from eligible donos with insufficient donation interval, and further improve the management of blood donors and blood safety in the Yangtze River Delta.

【Objective】 To introduce the construction of the electronic blood-donation certificate information system(EBDCIS) in Zhejiang province, including the construction foundation, system design, system function and preliminary development achieved. 【Methods】 A provincially unified EBDCIS, based on Internet and cloud computing technology relying on the Zhejiang blood cloud platform with Alipay and WeChat applet as service carriers, was developed in 2019, which was oriented towards " the Internet Plus blood donation service" . 【Results】 In addition to the realization of electronic blood-donation certificate, the system mainly improved the online service, including 6 categories as blood donation information query, blood donation navigation, facial recognition, satisfaction evaluation, blood use exemption and blood knowledge area, covering 21 functions. 【Conclusion】 The application of EBDCIS in Zhejiang province has provided better care and service for blood donors, and is conductive to establish one-stop blood donation service platform.