OBJECTIVE To provide technical support for improving recognition rate of adverse drug events （ADEs） related to traditional Chinese medicine （TCM） formula granules and decoction pieces among inpatient patients. METHODS By referencing the global trigger tool （GTT） whitepaper， literature on adverse reactions to TCM， and expert review opinions， ADE trigger items for TCM formula granules and decoction pieces used in the inpatients were established. GTT was applied to analyze ADEs in inpatients who had used TCM formula granules and decoction pieces in our hospital from August 2013 to August 2023， utilizing the Chinese Hospital Pharmacovigilance System. The effectiveness of GTT and the characteristics of these ADEs were analyzed. RESULTS A total of forty-eight triggers were established， including thirty-two laboratory test indexes， thirteen clinical symptoms， and three antidotes. Among the 1 682 patients included， GTT identified 652 potential ADEs， 284 true positive ADEs，with a trigger rate of 38.76% and a positive predictive value of 43.56%. After review by the auditor， 278 cases of ADEs were finally confirmed， with an incidence rate of 16.53%， significantly higher than the number of spontaneously reported ADEs during the same period （0）. The 278 cases of ADEs were mostly grade 1 （223 cases）， mainly involving hepatobiliary system， gastrointestinal system， blood- lymphatic system， etc；a total of 219 types of TCMs are involved，and the top five suspected TCMs used at a frequency higher than 1% were Poria cocos， Codonopsis pilosula， Atractylodes macrocephala， fried Glycyrrhiza uralensis， and Scutellaria baicalensis. CONCLUSIONS The established GTT can improve the recognition rate of ADEs for hospitalized patients using traditional Chinese medicine formula granules and decoction pieces.

Insomnia is a prevalent disorder characterized by difficulties in falling asleep or maintaining sleep.Chronic insomnia can severely impair physical and mental health,as well as quality of life.The traditional Chinese medicine(TCM)theory,"all the eleven zang organs depend on the gallbladder,"is derived from the chapter of Discussion on Six-Plus-Six System and the Manifestations of Organs of Plain Questions.It highlights the pivotal role of the gallbladder in maintaining visceral function.The gallbladder governs decision-making and plays a central role in sleep regulation by modulating spleen-stomach transportation and transformation,dispersing qi movement throughout the body,harmonizing yin and yang,and modulating ying and wei systems.Research has demonstrated that bile acids correspond closely with the gallbladder's TCM functions of"governing the earth zang"and"regulating the eleven zang organs,"serving as a crucial material basis for gallbladder physiology.Dysregulation of bile acid metabolism may contribute to insomnia through multiple pathways,including gastrointestinal dysfunction,disruption of gut microbiota balance,induction of neuroinflammation,and circadian rhythm disturbances.This study proposes that bile acid metabolism disorder may constitute a key pathological mechanism linking gallbladder dysfunction—according to TCM theory—to insomnia.Based on clinical experience,novel therapeutic strategies are proposed under the framework of"regulating the gallbladder to tranquilize mind",including the use of gallbladder-related materials,prioritized application of liver-regulating herbs,and implementation of a sleep rhythm reconstruction protocol.

Objective To investigate the different biomechanical effects of two types of palatal expanders and expansion sites on a bi-lateral complete cleft lip and palate(BCCLP)in mixed dentition with a finite element analysis(FEA).Methods The CBCT data of a patient with BCCLP were collected to construct a FEA model containing craniomaxillary suture structure.The fan-shaped and traditional Hyrax expanders were drawn and assembled into the FEA model in SolidWorks software according to the working conditions as follows:condition 1 and 2,the fan-shaped expander was placed at the anterior/posterior part of the palate respectively;condition 3 and 4,the Hyrax expander was placed at the anterior/posterior part of the palate respectively.A 5 N force in X axis direction was loaded at the apex of the expander coil spring.The stress distribution and initial displacement of craniomaxillary complex in four working conditions were compared.Results ①In working condition 1,2 and 3,the displacement of anterior part was larger than the posterior part of the dental arch.Under condition 4,the displacement of anterior,middle and posterior parts of dental arch were basically the same.②The maximum stress and displacement were observed at crowns in all working conditions.③There was a certain skeletal enlargement effect,which showed a gradually decreasing deformation trend from alveolar region to the upward region.Conclusion The expansion effect of fan-shaped expander is more suitable for BCCLP patients with extremely narrow anterior arch and normal posterior arch.For the tradi-tional Hyrax expander,the position has a great influence on expansion effect.It is showed that the dental support expander could pro-duce skeletal dilation effect in BCCLP patients during mixed dentition.

Insomnia is a prevalent disorder characterized by difficulties in falling asleep or maintaining sleep.Chronic insomnia can severely impair physical and mental health,as well as quality of life.The traditional Chinese medicine(TCM)theory,"all the eleven zang organs depend on the gallbladder,"is derived from the chapter of Discussion on Six-Plus-Six System and the Manifestations of Organs of Plain Questions.It highlights the pivotal role of the gallbladder in maintaining visceral function.The gallbladder governs decision-making and plays a central role in sleep regulation by modulating spleen-stomach transportation and transformation,dispersing qi movement throughout the body,harmonizing yin and yang,and modulating ying and wei systems.Research has demonstrated that bile acids correspond closely with the gallbladder's TCM functions of"governing the earth zang"and"regulating the eleven zang organs,"serving as a crucial material basis for gallbladder physiology.Dysregulation of bile acid metabolism may contribute to insomnia through multiple pathways,including gastrointestinal dysfunction,disruption of gut microbiota balance,induction of neuroinflammation,and circadian rhythm disturbances.This study proposes that bile acid metabolism disorder may constitute a key pathological mechanism linking gallbladder dysfunction—according to TCM theory—to insomnia.Based on clinical experience,novel therapeutic strategies are proposed under the framework of"regulating the gallbladder to tranquilize mind",including the use of gallbladder-related materials,prioritized application of liver-regulating herbs,and implementation of a sleep rhythm reconstruction protocol.

Objective To investigate the different biomechanical effects of two types of palatal expanders and expansion sites on a bi-lateral complete cleft lip and palate(BCCLP)in mixed dentition with a finite element analysis(FEA).Methods The CBCT data of a patient with BCCLP were collected to construct a FEA model containing craniomaxillary suture structure.The fan-shaped and traditional Hyrax expanders were drawn and assembled into the FEA model in SolidWorks software according to the working conditions as follows:condition 1 and 2,the fan-shaped expander was placed at the anterior/posterior part of the palate respectively;condition 3 and 4,the Hyrax expander was placed at the anterior/posterior part of the palate respectively.A 5 N force in X axis direction was loaded at the apex of the expander coil spring.The stress distribution and initial displacement of craniomaxillary complex in four working conditions were compared.Results ①In working condition 1,2 and 3,the displacement of anterior part was larger than the posterior part of the dental arch.Under condition 4,the displacement of anterior,middle and posterior parts of dental arch were basically the same.②The maximum stress and displacement were observed at crowns in all working conditions.③There was a certain skeletal enlargement effect,which showed a gradually decreasing deformation trend from alveolar region to the upward region.Conclusion The expansion effect of fan-shaped expander is more suitable for BCCLP patients with extremely narrow anterior arch and normal posterior arch.For the tradi-tional Hyrax expander,the position has a great influence on expansion effect.It is showed that the dental support expander could pro-duce skeletal dilation effect in BCCLP patients during mixed dentition.

Objective To explore the effect of establishing doctoral research fund,provide reference for scientific research development at local medical colleges.Methods Chi-square test was conducted to find out the statistical difference of the project establishment and output of funded members in five years' time before and after the funding establishment.Results Before and after the establishment of the fund,the number of projects and papers published increased significantly,with statistical significance (P＜0.05),and the growth rate of fund indicators was greater than the total growth rate of colleges.Conclusions Based on the connotation construction of scientific research at institutional level,establishment of the funding helps to improve the scientific research at medical colleges.In face of identified problems,it is suggested to improve management system of the fund,optimize the project process management,innovate the incentive mechanism and strengthen the integration of research team to promote the sustainable development of scientific research.

OBJECTIVETo investigate the risk factors for metastasis and clinical indications for dissection of lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC).

METHODSA prospective analysis including 283 consecutive patients with PTC who underwent total thyroidectomy with routine central lymph node dissection (CLND) in our hospital from Jan. 2010 to Jan. 2012 was performed. The right paratracheal lymph nodes in the central compartment lymph nodes (CCLN) were divided into the anterior (level VIa) and posterior (level VIb) compartments by recurrent laryngeal nerve (RLN), and were removed respectively. The complications and recurrences were recorded with a follow-up of 3 months to 3 years.

RESULTSCCLN metastases were present in 47.7% (135/283) of the patients, and level VIb metastases were present in 27.2% (77/283) of the patients. The incidence of level VIb metastasis was 20.5% (58/283) in level VIa-positive patients, while 6.7% (19/283) in level VIa-negative patients. Complications of level VIb dissection were found in 4.9% (14/283) of all patients. 2.1% (6/283) of all patients were diagnosed with regional recurrence during the 3-year follow-up. Univariate analysis revealed that level VIb metastasis was significantly associated with tumor size, number, extrathyroidal invasion, clinical nodal stage, level VIa and lateral lymph node metastases. Multivariate analysis revealed that tumor larger than 1 cm, multifocality, extrathyroidal invasion, level VIa and lateral lymph node metastases were independent risk factors for level VIb metastasis.

CONCLUSIONSLymph node posterior to right recurrent laryngeal nerve can be the only site of metastasis from PTC without other cervical compartment involvements. Therefore, routine intraoperative detection of these nodes may be necessary for patients with right PTC, and dissection should be considered when a right-side PTC tumor is larger than 1 cm, multifocality, with extrathyroidal invasion or cervical nodal metastases.

Carcinoma ; pathology ; surgery ; Carcinoma, Papillary ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Prospective Studies ; Recurrent Laryngeal Nerve ; pathology ; Risk Factors ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; Tumor Burden

Objective To investigate the ED50 and ED9 5 of subarachnoid 0.375% bupivacaine in elderly patients undergoing elective total hip arthroplasty (THA ) in high altitude area. Methods Twenty-three elderly patients,aged 73-99 years old,ASA Ⅱ or Ⅲ,selected for total hip ar-throplasty (THA)under combined spinal-epidural (CSE)anesthesia were enrolled in this study and predose of 3.0 mg,0.375% (m/v)bupivacaine administered in subarachnoid,following dosage in-creased by ratio of 0.8.Calculate the ED50 and ED9 5 of subarachnoid 0.375% bupivacaine and 95%CI.Results Twenty of 23 underwent the test completely.The ED50 (95%CI)and ED9 5 (95%CI)of 0.375% (m/v)bupivacaine were 4.81 mg (3.98-5.81 )and 7.29 mg (6.03-8.81 ),respectively. Conclusion Subarachnoid 0.375% bupivacaine (7.5 mg)can be used effectively and safely in elderly patients undergoing total hip arthroplasty in high altitudes area.

Objective To establish a comprehensive evaluation indexing system to appraise the implications of prevention and treatment of HIV/AIDS ,and to calculate the weight of each indicator .Methods Based on the idea of performance and input-out-put ,professional consultation ,and Delphi method was determined as the evaluation index system ,analytical hierarchy process (AHP) was used to calculate the weight value for each indicator .Results The evaluation indexing system had been established af-ter three rounds of professional consultation .It contained two 1st class indicators ,six 2nd class indicators and thirty-one in 3rd class indicators .The weight value of each indicator was calculated .Conclusion The evaluation indexing system that has been established and the weight value quantities are of completeness ,practicality ,operability and logic .They have important value for application in the future .

Objective To summarize the anatomic variations of recurrent laryngeal nerve (RLN during thyroid surgery and to investigate the technical key points for identification and preservation of the nerve.Methods Clinical data of 1548 consecutive patients undergoing thyroid operation with intraoperative routine exposure of RLN from June 2010 to June 2012 was retrospectively analyzed.Results In this series,2620 RLNs at risk were clearly exposed and identified during a total of 1548 thyroid operations,wherein complete dissection was performed on 1886 nerves.Injury occurred in 11 of 2620 (0.42％) nerves.Through the analysis of all 2620 RLNs,conditional variations were found in 64 nerves.Of 1886 RLNs that were completely dissected,421 (22.3％)nerves presented with natural variations of six patterns,including morphological branching variation in 126 (6.68％) nerves,course and location variation in 124 (6.57％)nerves,variation in relationship with inferior thyroid artery (ITA)in 36 (1.91％)nerves,variation at the Berry ligament in 112 (5.94％) nerves,variation at the cricothyroid joint in 17 (0.80％) nerves,and 6 (0.32％)cases of non-recurrent laryngeal nerve (nRLN).Conclusions Variations in RLN found during thyroid surgery are of relatively high incidence,complex and diverse,which can be a potential reason of nerve injury due to visual misidentification.Thus,a thorough knowledge of the normal anatomy of RLN and its anatomic variations ensures a safe and effective thyroid surgery.