Objective To investigate the clinical value of thromboelastography (TEG) in monitoring the coagulation function change after plasma supplementation in the patients with severe liver cirrhosis diges-tive tract hemorrhage.Methods A total of 48 patients with high risk and extreme high risk liver cirrhosis a-cute upper digestive hemorrhage receiving the treatment in ICU of this hospital from February 2020 to March 2023 were selected as the study subjects.After plasma infusion with the dose of 10 mL/kg,the coagulation function status was detected.The patients were divided into the TEG group (n=20) and the control group (n=28) according to different detection modes of coagulation function.The TEG group simultaneously detec-ted TEG and traditional coagulation function detection,while the control group only conducted the traditional coagulation detection.TEG and coagulation function detection indicators after the infusion of plasma were compared between the two groups.The plasma infusion amounts at 24 h after admitting in ICU were recorded and the control status of digestive tract hemorrhage was evaluated.Results The R value in the TEG group was (8.02±6.09)min,the K vale was 2.5(1.3,5.0)min,the coagulation comprehensive index (CI) was-4.70±6.29,the maximal shear stress coefficient (MA) was 50.35±18.84,LY30 was 0.The Pearson corre-lation analysis showed that MA was positively correlated with FIB and PLT (r=0.470,0.526,P<0.05),and the other indexes had no correlation.Compared with the control group,the plasma infusion amounts in the TEG group was more[(419.00±143.18)mL vs. (400.00±137.54)mL],the digestive tract hemorrhage con-trol rate was higher[75.00％(15/20) vs. 53.57％(15/28)],but the differences were not statistically signifi-cant (P>0.05).The multiple linear regression was MA=-3.427+11.200×Ln(PLT)+10.230×Ln(FIB).Con-clusion In the patients with severe lever cirrhosis acute upper gastrointestinal bleeding,TEG could earlier find the co-agulation function improvement situation after plasma supplementation than the traditional coagulation detection.

Tea green leafhopper(TGL),Empoasca onukii,is of biological and economic interest.Despite numerous studies,the mechanisms underlying its adaptation and evolution remain enig-matic.Here,we use previously untapped genome and population genetics approaches to examine how the pest adapted to different environmental variables and thus has expanded geographically.We complete a chromosome-level assembly and annotation of the E.onukii genome,showing nota-ble expansions of gene families associated with adaptation to chemoreception and detoxification.Genomic signals indicating balancing selection highlight metabolic pathways involved in adaptation to a wide range of tea varieties grown across ecologically diverse regions.Patterns of genetic vari-ations among 54 E.onukii samples unveil the population structure and evolutionary history across different tea-growing regions in China.Our results demonstrate that the genomic changes in key pathways,including those linked to metabolism,circadian rhythms,and immune system functions,may underlie the successful spread and adaptation of E.onukii.This work highlights the genetic and molecular basis underlying the evolutionary success of a species with broad economic impacts,and provides insights into insect adaptation to host plants,which will ultimately facilitate more sustain-able pest management.

Objective: To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods: A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results: The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions: The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity.
Blood Loss, Surgical ; Debridement ; Female ; Humans ; Male ; Muscles/surgery* ; Osteomyelitis/surgery* ; Perforator Flap ; Pressure Ulcer/surgery* ; Reconstructive Surgical Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome

Objective:To analyze research status and development trends in the field of health management in China from 2011 to 2020.Methods:“CNKI” was chosen as the data source, and “health management（precise）” was used as the search term, and a total of 13, 686 valid data were finally obtained. Frequency counts were used to tabulate the number of articles published in the field of health management from 2011 to 2020. CiteSpace software was used to analyze the cooperation of institutions, and to explore the research hotspots and development trends in the field of health management by institutions co-occurrence, keyword co-occurrence and clustering timeline map. Bicomb software and SPSS 26.0 software were used for multi-dimensional scale analysis of keywords to comprehensively reflect the core degree and maturity of research topics.Results:The amount of domestic health management research literature had shown an increasing trend from 2011 (804) to 2020 (2 044). The top 5 keywords in terms of frequency were “hypertension（611）” “diabetes（577）” “health education（485）” “community（460）” and “chronic diseases（457）”. “Elderly” “Traditional Chinese Medicine（TCM health management）” and “Health management model” were the hot keywords and research trends of health management. There were 7 themes in the field of health management, namely “Construction and application of chronic diseases health management model” “Community health service and health management” “Health management in essential public health service” “Health management of the elderly” “Health management of Traditional Chinese Medicine” “Health examination and health management organization” “Health management based on big data and modern information technology”.Conclusions:A relatively close network of cooperation has been formed in the field of health management research and the number of articles has increased. The elderly, chronic disease and Traditional Chinese Medicine health management are the research trend. The construction and implementation of health management models, the integration of artificial intelligence and health management are the development trends in this field.

Objective To establish a modern hospital management system with clear rights and responsibilities, scientific management, perfect management, efficient operation and strong supervision. Methods 37 tertiary hospitals in Shanghai were subject to a simulation of observation, questionnaire investigation and quantitative analysis.On such basis,core regulations were pinpointed and management risk prevention grades identified according to their importance and risk indexes.Results 109 core regulations of modern hospital management were selected along with three management risk prevention and control levels of red(67 regulations), yellow(16 regulations), and blue(26 regulations).Conclusions The basic framework of management risk prevention and control system is thus built for modern hospitals,and IT-based means were put in place against such risks.These measures can help enhance the supervision platform, for dynamic supervision and effective control of modern hospital management risks.

Objective:To investigate the serum expression of long non-coding RNA overlapping transcription content KCNQ1OT1 (KCNQ1) gene in patients with coronary artery disease (CAD) and its clinical significance.
Methods:A total of 196 patients treated in our hospital were divided into 2 groups:CAD group and Control group, the patients were without CAD. n=98 in each group. Expression levels of serum KCNQ1OT1 and P53 were measured by quantitative RT-PCR;the relationship between KCNQ1OT1, P53 and clinical features in relevant patients were analyzed.
Results:Compared with Control group, CAD group had increased expression of serum KCNQ1OT1 and decreased expression of P53, both P<0.05. Correlation analysis revealed that the expression of KCNQ1OT1 was negatively related to P53 (r=-0.856, P<0.001);multi Logistic regression analysis indicated that serum KCNQ1OT1 was independently related to CAD (P<0.05).
Conclusion:CAD patients had obviously increased serum level of KCNQ1OT1;KCNQ1OT1 was independently related to CAD occurrence.

Extensive informed consent is a special form of informed consent.In foreign countries,the applica-tion and implementation of extensive informed consent has enhanced the circulation rate of biological samples in fu-ture research and promoted the development of the clinical research of biological samples.But it also has caused some ethical issues because of weakening informed such as:obtaining the information about the subject not in time,the research risks unknown and quiting research not in time.At present,Europe and the United States have conducted a lot of research in the implementation conditions,informed content and framework,providing a strong support for the practice of extensive informed consent.The practice of extensive informed consent has become the development direction of the biological samples research in our country.The author compared the social environ-ment and theoretical research at home and abroad and thought that our country must practice and implement it on the basis of social recognition,the improvement of ethical review mechanism and legislative protection.

Based on the review of the existing evidence of the research on the hospital management institutional ethics , this paper found researches in this area in the last two decades focused on the concept and level definition of hospital management institutional ethics;the construction of hospital management institutional ethics;the value and function of hospital management institutional ethics, and the reason and result of lack of hospital management insti-tutional ethics. On this basis, it pointed out the deficiency of the current researches and outlook the prospects.

By referring to the domestic and foreign relevant regulatory guidelines, this paper analyzed and sum-marized the ethical point in the design phase in the perspective of relevant regulations of clinical waste sample man-agement and biological sample management. It also analyzed the focus problems including the difference in sample library and clinical laboratory remaining sample as well as the ownership of the sample, to provide theoretical basis for ethics committee to review this kind of protocols.

INTRODUCTIONNecrotising fasciitis (NF) is often found in patients with diabetes mellitus, chronic renal failure, alcoholism, malignancy or liver cirrhosis. However, it remains unknown whether liver cirrhosis is an independent risk factor for the occurrence of NF. This study aimed to determine whether liver cirrhosis is an independent risk factor for the occurrence of NF, and to identify the relationship between severity of liver cirrhosis and occurrence of NF.

METHODSThe National Health Insurance Research Database, maintained by Taiwan's National Health Insurance programme, was retrospectively analysed, and the hospitalisation data of 40,802 cirrhotic patients and 40,865 randomly selected, age‑ and gender‑matched non‑cirrhotic control patients was collected. The medical records of all patients were individually followed for a three‑year period from the patients' first hospitalisation in 2004.

RESULTSDuring the three‑year follow‑up period, there were 299 (0.7%) cirrhotic patients with NF and 160 (0.4%) non‑cirrhotic patients with NF. Cox regression analysis showed that liver cirrhosis was a risk factor for the occurrence of NF during the study period (hazard ratio 1.982; p < 0.001). Among cirrhotic patients, those with complicated liver cirrhosis had a higher risk for the occurrence of NF than patients with non‑complicated liver cirrhosis (hazard ratio 1.320; p = 0.028).

CONCLUSIONCirrhotic patients had a higher risk for the occurrence of NF than non‑cirrhotic patients, and the risk for NF was especially high among patients with complicated liver cirrhosis.

Adult ; Age Factors ; Aged ; Alcoholism ; complications ; Comorbidity ; Fasciitis, Necrotizing ; complications ; physiopathology ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Liver Cirrhosis ; complications ; physiopathology ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sex Factors ; Taiwan ; Treatment Outcome