Objective:To observe the efficacy and safety of polatuzumab vedotin(pola)combined with chemotherapy in the treatment of relapsed and refractory diffuse large B-cell lymphoma(R/R DLBCL).Methods:A total of 23 patients with R/R DLBCL treated at the First Affiliated Hospital of Zhejiang University and its Liangzhu Branch from April 2023 to March 2024 were retrospectively collected.All patients were treated with pola combined with chemotherapy regimens such as BR,R-GDP,R-CHOP,or other regimens.Results:All 23 patients were evaluable for efficacy,with 10 achieving complete response(CR),7 partial response(PR),3 stable disease(SD),and 3 progressive disease(PD).The most common adverse events included myelosuppression,fever,and pulmonary infection.No severe adverse events resulted in drug withdrawal.Conclusion:Pola combined with chemotherapy demonstrates promising efficacy and a favorable safety profile in the treatment of R/R DLBCL.

Clinical pharmacist training is an important way to strengthen the clinical pharmacist team's construction and improve their pharmaceutical service capabilities and levels.The Pharmacy Administration and Pharmacy Practice in Healthcare Institutions-Part 4-8-1:Pharmacy Administration-Pharmacy Training Management-Clinical Pharmacist Training was based on the relevant requirements of the current clinical pharmacist training system of the Chinese Hospital Association,and formulated by sor-ting out relevant materials,such as standards,policies and regulations,technical specifications,literature,the current situation of clinical pharmacist training in China,and expert opinions.A total of 15 key elements of clinical pharmacist training were selected and divided into three aspects(base management,training process and assessment,and the quality management,evaluation and improvement).This article mainly introduced the construction method and content of the clinical pharmacist training standard,to deepen the understanding of the standard for relevant units and to promote the implementation of the standard.

Objective To investigate the impacts of epidural anesthesia with ropivacaine combined with dezocine on lower limb motor nerve block and maternal and infant outcomes in primipara undergoing painless delivery.Methods A total of 159 primiparas who delivered in Nanjing Jiangbei Hospital were selected as the research objects,and divided into the blank group(53 cases),the ropivacaine group(53 cases)and the combined group(53 cases)by the random number table method.Parturients in the blank group were given natural delivery mode,parturients in the ropivacaine group were given ropivacaine epidural anesthesia,and parturients in the combined group were given dezocine anesthesia on the basis of ropivacaine.Analgesic effect at different time points,time of the first,second and third stage of labor,pressing times of analgesic pump,lower limbs motor nerve block,maternal and infant outcomes,and adverse reactions of parturients were compared among the three groups.Results At 10 minutes after analgesia,60 minutes after analgesia,when the cervix was fully dilated and when the fetus was delivered,the VAS scores of the parturients in the ropivacaine group and the combined group were lower than those in the blank group(P<0.05),and the VAS scores of the parturients in the combined group were significantly lower than those in the ropivacaine group(P<0.05).There was no significant difference in the time of the first,second or third stage of labor of parturients among the three groups(P>0.05);The pressing times of analgesic pump of parturients in the combined group was significantly less than that in the ropivacaine group(P<0.05).There was no statistically significant difference in terms of low limb motor nerve block after painless labor of parturients among the three groups(P>0.05).There were no statistically significant differences in the perineal incision rate or the Apgar scores of newborns at 1 minute and 5 minutes after birth among the three groups(P>0.05).The usage rate of forceps and the rate of conversion to cesarean section in the combined group were significantly lower than those in the ropivacaine group and the blank group(P<0.05).There was no statistically significant difference in the incidence of total adverse reactions among the blank group,the ropivacaine group and the combined group(P>0.05).Conclusion The combination of ropivacaine and dezocine for epidural anesthesia has a better analgesic effect on primiparas with painless delivery,has a smaller impact on lower limb motor nerve block in parturients,and can achieve better maternal and infant outcomes.

In recent years, the relationship between gut microbiota and various systemic diseases has been increasingly elucidated, and its role in the male reproductive system has attracted growing attention. The gut microbiota, a complex and vast microbial community residing in the human intestine, is involved in the regulation of male fertility through multiple mechanisms, including modulation of sex hormone levels, inflammatory responses, microbial metabolites, immune regulation, and endocrine signaling pathways. Furthermore, dietary interventions, lifestyle modifications, and medical therapies can improve male fertility by restoring gut microbial balance. Exploring the intricate relationship between gut microbiota and male fertility holds significant scientific and clinical value. This review summarizes the current research progress on the mechanisms underlying the relationship between gut microbiota dysbiosis and male fertility, and discusses the potential of interventions targeting gut microbiota dysbiosis as a novel strategy to improve reproductive outcomes.

Objective:To observe the efficacy and safety of polatuzumab vedotin(pola)combined with chemotherapy in the treatment of relapsed and refractory diffuse large B-cell lymphoma(R/R DLBCL).Methods:A total of 23 patients with R/R DLBCL treated at the First Affiliated Hospital of Zhejiang University and its Liangzhu Branch from April 2023 to March 2024 were retrospectively collected.All patients were treated with pola combined with chemotherapy regimens such as BR,R-GDP,R-CHOP,or other regimens.Results:All 23 patients were evaluable for efficacy,with 10 achieving complete response(CR),7 partial response(PR),3 stable disease(SD),and 3 progressive disease(PD).The most common adverse events included myelosuppression,fever,and pulmonary infection.No severe adverse events resulted in drug withdrawal.Conclusion:Pola combined with chemotherapy demonstrates promising efficacy and a favorable safety profile in the treatment of R/R DLBCL.

Objective To analyze the efficacy and safety of different doses of esketamine for laparoscopic high hernia sac ligation in school-age children.Methods The school-age children who underwent laparoscopic high ligation of hernia sac were divided into small-dose group and conventional-dose group according to cohort method.The conventional-dose group was given intravenous 0.75 mg·kg-1 esketamine hydrochloride injection to prepare for induction;the small-dose group was given intravenous 0.50 mg·kg-esketamine hydrochloride injection to prepare for induction,and the two groups were given the same anesthesia induction,anesthesia maintenance and postoperative analgesia.The recovery time,laryngeal mask removal time,anesthesia recovery room residence time,children face,legs,activity,cry,consolability behavioral tool(FLACC)score of the children in the two groups were observed,the hemodynamic indexes were recorded at the time of entry(T1),before anesthesia induction(T2),immediately after laryngeal mask placement(T3),and the safety was evaluated.Results A total of 39 cases and 43 cases children were included in the conventional-dose group and the small-dose group,respectively.After treatment,the recovery time of conventional-dose group and small-dose group were(26.36±3.91)and(23.21±3.55)min;the time of removing laryngeal mask were(13.02±2.15)and(12.24±2.30)min;the retention time of postanesthesia care unit(PACU)were(37.23±5.64)and(32.11±5.36)min;the scores of FLACC were(2.08±0.45)and(2.16±0.51)points,respectively.At T1,T2 and T3,the heart rate(HR)of the conventional-dose group were(99.23±15.78),(102.19±17.20)and(118.30±14.96)beat·min-1;that of the small-dose group were(99.93±16.27),(103.28±16.75)and(120.19±15.39)beat·min-1,respectively.The mean arterial pressure(MAP)of the conventional-dose group were(84.56±7.22),(85.92±6.96)and(89.89±7.02)mmHg;that of the small-dose group were(84.88±6.87),(86.16±6.45)and(91.12±7.31)mmHg,respectively.There were statistically significant differences in the recovery time and PACU retention time between the small-dose group and the conventional-dose group(all P＜0.05).The adverse drug reactions in the two groups mainly included nausea and vomiting,increased secretions and transient hypertension.The incidence of total adverse drug reactions in the conventional-dose group and the small-dose group were 10.26％and 4.65％,respectively,with no statistical significance(P＞0.05).Conclusion Small-dose esketamine hydrochloride injection can effectively maintain hemodynamic stability in the preoperative intravenous administration of school-age children undergoing laparoscopic high ligation of hernia sac,and the effect of reducing postoperative pain and inhibiting agitation during the recovery period is comparable to that of conventional-dose,with good safety.

Objective:To systematically analyze the impact of various physician payment methods on medical service delivery behavior and outcomes.Methods:Based on the scoping review method,2 255 documents related to"physician","compensation","payment method",and"physician behavior"were retrieved from Web of Science,CNKI,VIP,and WanFang databases,and finally 70 studies were included based on scientific screening standards and process.Results:Fee-for-service encourages physicians to deliver an adequate volume of services but is susceptible to overtreatment;salary and capitation assist in controlling costs but can lead to insufficient service provision;the advantages of DRG/DIP in the quantity and quality of medical services weaken as the patient's condition worsens.Mixed payment methods can effectively balance the quantity and cost of medical services,while pay-for-performance is generally outstanding in improving quality.Conclusions:It is difficult for a single payment method to achieve the optimization of medical service delivery behavior and outcomes.A mixed payment system that integrates multiple payment methods with quality incentives must be established urgently.At the same time,it is recommended to deepen the reform of the mechanism for converting medical insurance balance into physician compensation,fully implement the allocation autonomy of public hospitals,and accelerate the establishment of a mixed physician payment method that is coordinated with medical insurance payment and performance appraisal.

Objective To investigate the regulatory effect of lipocalin 2(LCN2)on epidermal growth factor receptor(EGFR)phosphorylation and its impact on inflammatory damage in human fallopian tube epithelial cells.Methods Human fallopian tube epithelial cells were isolated and a lipopolysaccharide(LPS)intervention was applied to establish an in vitro cell model.The cells were randomly assigned into the following groups:a blank control group(Control),a model group(Model),experimental groups(Model+si-LCN2 or Model+oe-LCN2),and negative control groups(Model+si-NC or Model+oe-NC).Changes in cell viability,apoptosis rates,inflam-matory levels,as well as the expression of EGFR mRNA,LCN2,EGFR,p-EGFR,and the ratio of p-EGFR/EGFR proteins were evaluated.Results Compared to the Model group,the Model+si-LCN2 group exhibited enhanced cell viability,a reduced apoptosis rate,and decreased expression of inflammatory factors(P＜0.05).Immunopre-cipitation analysis confirmed a direct interaction between LCN2 and EGFR.In comparison with the Model group,the Model+oe-LCN2 group demonstrated elevated levels of p-EGFR and the p-EGFR/EGFR ratio(P＜0.05),while no significant change was observed in total EGFR expression(P＞0.05).Conclusion Inhibition of LCN2-mediated EGFR phosphorylation enhances cell viability,reduces apoptosis,and mitigates inflammatory responses,thereby ameliorating LPS-induced inflammatory injury in human fallopian tube epithelial cells.

Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.

AIM To study the chemical constituents from Inula japonica Thunb.and their anti-asthmatic activity.METHODS Separation and purification were performed using silica gel and Sephadex LH-20,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The effect of compounds on the release rate of β-Hex was evaluated by substrate coloration method.RESULTS Twenty-three compounds were isolated and identified as dehydrodontic acid(1),vitexin(2),alternariol(3),globuxanthone(4),1,3,6,7-tetrahydroxyxanthone(5),hydroxyhydrolapachol(6),isoscopoletin(7),elephanmollen(8),benzoylcholine(9),hoconobiflavone(10),clovandiol(11),hydroxydihydrobovolide(12),5,7-dihydroxycoumarin(13),scopoletin(14),orlichenol glucoside(15),urolignoside(16),9-angeloyloxythymol(17),6,3′,4′-trihydroxyaurone(18),flufuran(19),sweroside(20),guajadial(21),5,7,4′-trimethoxy-4-phenylcoumarin(22),dibutylphthalate(23).After intervention with compounds 9 and 16,the release rates of β-Hex were(56.64±2.37)％and(58.07±2.29)％,respectively.CONCLUSION Compounds 1-23 are isolated from Ⅰ.japonica for the first time.Compounds 9 and 16 have anti-asthmatic activity.