Objective:To apply statistical process control (SPC) techniques to the quality assurance of non-normal radiotherapy plans through Johnson transformation, establishing patient-specific tolerance and action limits based on treatment sites and dose/distance assessment criteria, thereby enhancing the intensity-modulated radiation therapy (IMRT) verification accuracy and dose delivery precision.Methods:In this study, 951 gamma analysis data of patient-specific quality assurance (PSQA) executed on the Halcyon accelerator platform were selected and categorized into six groups based on treatment sites, including brain (102 cases), head and neck (100 cases), breast (229 cases), lung (154 cases), esophagus (223 cases), and pelvic (143 cases) groups. The six groups of data were statistically analyzed through Anderson-Darling normality tests ( α = 0.05) using Minitab 21 software. Non-normal data were transformed into normal data through Johnson transformation and then were used to establish treatment site-specific tolerance and action limits, which were compared with the Shewhart control charts based on normal distributions. Results:The PSQA result of the six groups all exhibited non-normal distributions ( P < 0.05). Through Johnson transformation, the tolerance and action limits for the head and neck, breast, lung, esophagus, and pelvic areas under the 3%/2 mm criterion ranged from 95.13% to 96.16% and 94.19% to 95.91%, respectively. In contrast, the tolerance and action limits ranged from 91.15% to 94.86% and 89.94% to 94.78% under the 2%/2 mm criterion. Directly applying Shewhart control charts without normality assumptions yielded higher tolerance limits compared to the application of Johnson transformation, increasing the false positive rate in the non-normal PSQA process. Conclusions:Applying the SPC techniques directly to a non-normal process can lead to an increased false alarm rate and wrong process interpretation. The SPC techniques combined with Johnson transformation enable more effective monitoring of a non-normal PSQA process, facilitating timely identification of potential factors that may lead to an out-of-control process based on the treatment site-specific limits.

Objective:To establish a stable rat model of sequelae of pelvic inflammatory disease(SPID)with clinical characteristics,and to provide a reliable experimental model for the study of the pharmcological effect and mechanism of SPID.Methods:Twenty-four 7-week-old SD rats were divided into sham operation group,model-A(108 cfu/mL mixed bacterial solution,0.2 mL),model-B(109 cfu/mL mixed bacterial solution 0.2 mL),and model-C(108 cfu/mL E.coli 0.2 mL).The weight of the rat's uterine was weighed and the uterine index was calculated.The automatic hematology analyzer was used to detect the blood routine;hematoxylin-eosin staining(HE)and masson staining were used to detect uterine pathlogical changes in rats.Enzyme-linked immunosorbent assay(ELISA)was used to detect interleukin-1β(IL-1β),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in rat uterine tissue homogenates.Western blot was used to detect the expression of proteins related to NF-κB signaling pathway.Results:Compared with the sham operation group,the uterine index of model-A,model-B,and model-C were significantly increased(P＜0.05,P＜0.01).The levels of WBC and NE in the model-A increased significantly(P＜0.01).The level of LY in model-B decreased significantly(P＜0.01).The levels of IL-1β,TNF-α in model-A,model-B,and model-C were significantly increased(P＜0.01).The levels of IL-6 in model-A and model-B were significantly increased(P＜0.05,P＜0.01).The collagen volume fraction of model-A and model-B were significantly increased(P＜0.01).Mechanism study indicates that the expression levels of p-IKKβ/IKKβ,p-IκBα/IκBα and p-p65/p65 in model-A were significantly increased(P＜0.01),and the expression levels of IκBα/β-actin were significantly decreased(P＜0.01).The expression level of p-IKKβ/IKKβ in model-B was significantly increased(P＜0.01).Conclusions:A stable rat model of SPID that conforms to clinical characteristics can be successfully constructed by combining 0.2 mL of mixed bacterial solution with a concentration of 108 cfu/mL and mechanical injury.This modeling method intervened in the expression of the NF-κB inflammatory signaling pathway.

Organizational and institutional management plays a pivotal role in the pharmaceutical management of medi-cal institutions.Strengthening management in this area significantly enhances the quality of medical services and promotes the standardization,refinement,and scientific management of hospitals at all levels and types.To achieve homogenization in organiza-tional and institutional management,the Pharmaceutical Specialized Committee,Chinese Hospital Association compilation team adhered to principles of scientific,universality,instructiveness,and operability.After in-depth problem sorting,extensive opinion collection,and rigorous expert deliberation,we have formulated the first domestic group standard for regulating the organizational and institutional systems of pharmaceutical management in medical institutions.This article aims to detail the process of formula-ting this standard and to provide an in-depth analysis of its content,hoping to offer valuable advice and guidance for the construc-tion of organizational and institutional management in pharmaceutical affairs for medical institutions of all levels and types.

Objective To compare the accuracy differences of three-dimensional reconstruction of zygomatic-maxillary complex using cone beam computed tomography(CBCT)and multi-slice spiral computed tomography(MSCT)in the parameters related to zygomatic implantation.Methods Five adult skull specimens(10 zygomatic-maxillary complexes in total)were selected.According to the clinical application characteristics of zygomatic implantation,the parameter location for each skull specimen was conducted,and then CBCT and MSCT were used for scanning and three-dimensional reconstruction.Four parameters were measured on both skull specimens and reconstructed models:the thickness of the maxillary zygomatic process at the intersection of the zygomatic implant path and zygomaticomaxil-lary suture(LB-B1),the thickness of the zygomatic bone at the intersection of the zygomatic implant path and the midpoint of the zygomatic bone surface(LC-C1),the width of the alveolar ridge between the second premolar and the first molar(LAR),and the buccolingual width of the first molar(LM).The specimen group was measured by electronic vernier caliper,and the CBCT group and MSCT group were measured based on CBCT and MSCT.The absolute and relative errors of these four parameters were calculated,and the accuracy of the CBCT and MSCT three-dimensional reconstruction models were analyzed.Results All parameters demonstrated excellent measurement reliability and repeatability,with intra-class correlation coefficient(ICC)≥0.90.The measurement results of each parameter in the CBCT group and the MSCT group showed statistically significant differences compared with those in the specimen group(P<0.05).The measurement result of LM in the CBCT group was smaller than that in the MSCT group,and the difference was statistically significant(P<0.05).However,the measurement results of LB-B1,LC-C1 and LAR in the CBCT group showed no statistically significant difference compared with those in the MSCT group(P>0.05).The mean absolute error and relative error of the LM measurement results to the specimen group in the CBCT group were both smaller than those in the MSCT group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the mean absolute error or relative error of the LB-B1,LC-C1 and LAR measurement results to the specimen group between the CBCT group and the MSCT group(P>0.05).Conclusion CBCT and MSCT demonstrat comparable accuracy in three-dimensional reconstruction of the zygomatic-maxillary complex.However,CBCT exhibits superior accuracy for fine structures such as dental tissues,which is recommended as the primary choice for imaging data acquisition in zygomatic implantation.

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 explore the effect of Taichi motor imagination therapy combined with resistance exercise on the recovery of heart function and quality of life in patients with chronic heart failure(CHF).Methods:A total of 118 elderly CHF patients admitted to Huangshan Shoukang Hospital between January 2020 and December 2023 were included in this randomized controlled trial.Participants were randomly divided into intervention group(n=59)and control group(n=59).Participants in the control group received conventional anti-heart failure treatment,while those in the intervention group received additional Taichi motor imagination therapy and resistance exercise.The in-tervention lasted for 3 months.Cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd)and interventricular septal thickness at diastole(IVSTd)],quality of life[Minnesota Living with Heart Failure Questionnaire(MLHFQ)],markers of heart failure and neurohormones[B-type natri-uretic peptide(BNP),norepinephrine(NE),aldosterone(ALD)and angiotensin Ⅱ(AngⅡ)]levels and the inci-dence of major adverse cardiovascular events(MACE)during intervention were compared between the two groups.Results:Compared to those in the control group,participants in the intervention group had significant higher LVEF[(50.52±1.96)％vs.(45.84±2.21)％],and significant lower LVEDd[(57.12±1.72)mm vs.(60.45±2.14)mm],IVSTd[(8.84±0.82)mm vs.(10.00±1.19)mm],MLHFQ score[(28.86±5.34)points vs.(34.51±6.57)points],BNP[(9.23±1.35)pg/ml vs.(13.62±1.49)pg/ml],NE[(13.09±0.93)pmol/L vs.(16.63±0.86)pmol/L],ALD[(1.82±0.12)ng/L vs.(2.35±0.15)ng/L],AngⅡ[(0.75±0.07)ng/L vs.(0.90±0.06)ng/L]and incidence of MACE(6.90％vs.26.32％)(P＜0.01 all).Conclusion:Taichi motor imagination therapy combined with resistance exercise may improve the cardiac function and quality of life in CHF patients.

Objective:To apply statistical process control (SPC) techniques to the quality assurance of non-normal radiotherapy plans through Johnson transformation, establishing patient-specific tolerance and action limits based on treatment sites and dose/distance assessment criteria, thereby enhancing the intensity-modulated radiation therapy (IMRT) verification accuracy and dose delivery precision.Methods:In this study, 951 gamma analysis data of patient-specific quality assurance (PSQA) executed on the Halcyon accelerator platform were selected and categorized into six groups based on treatment sites, including brain (102 cases), head and neck (100 cases), breast (229 cases), lung (154 cases), esophagus (223 cases), and pelvic (143 cases) groups. The six groups of data were statistically analyzed through Anderson-Darling normality tests ( α = 0.05) using Minitab 21 software. Non-normal data were transformed into normal data through Johnson transformation and then were used to establish treatment site-specific tolerance and action limits, which were compared with the Shewhart control charts based on normal distributions. Results:The PSQA result of the six groups all exhibited non-normal distributions ( P < 0.05). Through Johnson transformation, the tolerance and action limits for the head and neck, breast, lung, esophagus, and pelvic areas under the 3%/2 mm criterion ranged from 95.13% to 96.16% and 94.19% to 95.91%, respectively. In contrast, the tolerance and action limits ranged from 91.15% to 94.86% and 89.94% to 94.78% under the 2%/2 mm criterion. Directly applying Shewhart control charts without normality assumptions yielded higher tolerance limits compared to the application of Johnson transformation, increasing the false positive rate in the non-normal PSQA process. Conclusions:Applying the SPC techniques directly to a non-normal process can lead to an increased false alarm rate and wrong process interpretation. The SPC techniques combined with Johnson transformation enable more effective monitoring of a non-normal PSQA process, facilitating timely identification of potential factors that may lead to an out-of-control process based on the treatment site-specific limits.

Organizational and institutional management plays a pivotal role in the pharmaceutical management of medi-cal institutions.Strengthening management in this area significantly enhances the quality of medical services and promotes the standardization,refinement,and scientific management of hospitals at all levels and types.To achieve homogenization in organiza-tional and institutional management,the Pharmaceutical Specialized Committee,Chinese Hospital Association compilation team adhered to principles of scientific,universality,instructiveness,and operability.After in-depth problem sorting,extensive opinion collection,and rigorous expert deliberation,we have formulated the first domestic group standard for regulating the organizational and institutional systems of pharmaceutical management in medical institutions.This article aims to detail the process of formula-ting this standard and to provide an in-depth analysis of its content,hoping to offer valuable advice and guidance for the construc-tion of organizational and institutional management in pharmaceutical affairs for medical institutions of all levels and types.

Objective To compare the accuracy differences of three-dimensional reconstruction of zygomatic-maxillary complex using cone beam computed tomography(CBCT)and multi-slice spiral computed tomography(MSCT)in the parameters related to zygomatic implantation.Methods Five adult skull specimens(10 zygomatic-maxillary complexes in total)were selected.According to the clinical application characteristics of zygomatic implantation,the parameter location for each skull specimen was conducted,and then CBCT and MSCT were used for scanning and three-dimensional reconstruction.Four parameters were measured on both skull specimens and reconstructed models:the thickness of the maxillary zygomatic process at the intersection of the zygomatic implant path and zygomaticomaxil-lary suture(LB-B1),the thickness of the zygomatic bone at the intersection of the zygomatic implant path and the midpoint of the zygomatic bone surface(LC-C1),the width of the alveolar ridge between the second premolar and the first molar(LAR),and the buccolingual width of the first molar(LM).The specimen group was measured by electronic vernier caliper,and the CBCT group and MSCT group were measured based on CBCT and MSCT.The absolute and relative errors of these four parameters were calculated,and the accuracy of the CBCT and MSCT three-dimensional reconstruction models were analyzed.Results All parameters demonstrated excellent measurement reliability and repeatability,with intra-class correlation coefficient(ICC)≥0.90.The measurement results of each parameter in the CBCT group and the MSCT group showed statistically significant differences compared with those in the specimen group(P<0.05).The measurement result of LM in the CBCT group was smaller than that in the MSCT group,and the difference was statistically significant(P<0.05).However,the measurement results of LB-B1,LC-C1 and LAR in the CBCT group showed no statistically significant difference compared with those in the MSCT group(P>0.05).The mean absolute error and relative error of the LM measurement results to the specimen group in the CBCT group were both smaller than those in the MSCT group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the mean absolute error or relative error of the LB-B1,LC-C1 and LAR measurement results to the specimen group between the CBCT group and the MSCT group(P>0.05).Conclusion CBCT and MSCT demonstrat comparable accuracy in three-dimensional reconstruction of the zygomatic-maxillary complex.However,CBCT exhibits superior accuracy for fine structures such as dental tissues,which is recommended as the primary choice for imaging data acquisition in zygomatic implantation.

Diterpenoid ferruginol is a key intermediate in biosynthesis of active ingredients such as tanshinone and carnosic acid.However, the traditional process of obtaining ferruginol from plants is often cumbersome and inefficient. In recent years, the increasingly developing gene editing technology has been gradually applied to the heterologous production of natural products, but the production of ferruginol in microbe is still very low, which has become an obstacle to the efficient biosynthesis of downstream chemicals, such as tanshinone. In this study, miltiradiene was produced by integrating the shortened diterpene synthase fusion protein,and the key genes in the MVA pathway were overexpressed to improve the yield of miltiradiene. Under the shake flask fermentation condition, the yield of miltiradiene reached about(113. 12±17. 4)mg·L~(-1). Subsequently, this study integrated the ferruginol synthase Sm CYP76AH1 and Sm CPR1 to reconstruct the ferruginol pathway and thereby realized the heterologous synthesis of ferruginol in Saccharomyces cerevisiae. The study selected the best ferruginol synthase(Il CYP76AH46) from different plants and optimized the expression of pathway genes through redox partner engineering to increase the yield of ferruginol. By increasing the copy number of diterpene synthase, CYP450, and CPR, the yield of ferruginol reached(370. 39± 21. 65) mg·L~(-1) in the shake flask, which was increased by 21. 57-fold compared with that when the initial ferruginol strain JMLT05 was used. Finally, 1 083. 51 mg·L~(-1) ferruginol was obtained by fed-batch fermentation, which is the highest yield of ferruginol from biosynthesis so far. This study provides not only research ideas for other metabolic engineering but also a platform for the construction of cell factories for downstream products.
Saccharomyces cerevisiae/genetics* ; Diterpenes/metabolism* ; Metabolic Engineering ; Fermentation ; Abietanes