Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Objective To explore and analyze the application effect of the digital information management mode of nurs-ing"teaching-training-clinical"work in operating room teaching.Methods 100 nursing students who interned in the operating room of Gaozhou Hospital of Traditional Chinese Medicine from April 2023 to February 2024 were selected as the research sub-jects.They were divided into an observation group(digital information management mode of"teaching-training-clinical"work)and a control group(traditional teaching mode)by random number table method,with 50 students in each group.The teaching effects of the two groups were compared.Results The theoretical and practical scores and core competency scores of the obser-vation group after teaching were significantly higher than those of the control group.The observation group had higher satisfaction with the teaching plan,teaching content,teaching methods,teaching achievements,and teaching ability,and the comparison was statistically significant(P＜0.05).The long-term teaching results of the observation group,including theoretical and practical assessment results and core competency assessment results,were higher than those of the control group(P＜0.05).Conclusion The digital information management mode of"teaching-training-clinical"work can improve the teaching quality of operating room teaching and enhance the working ability of nursing students.

Objective To understand the implementation of WS/T 508-2016 and the status of washing and disin-fection of medical textiles in China,and provide basis for the revision of the standard.Methods A questionnaire survey was conducted on the management of medical institutions and washing and disinfection workplace,building layout,personnel protection,equipment and supplies,washing and disinfection principles,and hygiene quality mo-nitoring of medical textiles in 323 medical institutions and 31 washing institutions in China.Meanwhile,microbio-logical index sampling was conducted on 234 pieces of medical textiles in 9 medical institutions and 8 washing insti-tutions in Hubei,Shanxi,Shanghai,and Sichuan Provinces before and after washing and disinfection.Results The awareness rates of WS/T 508-2016 among medical institutions and washing institutions were 96.90％and 96.77％,respectively,and the implementation rates were 94.12％and 96.77％,respectively.47.99％medical in-stitutions use purchasing services for washing and disinfecting medical textiles,and the higher the level of the medi-cal institution was,the higher the proportion of purchasing services was(x2=15.312,P＜0.001).85.16％medi-cal institutions have conducted risk assessments on service providers,and 52.99％were responsible for or participa-ted in pre-job training by the medical institution.Washing institutions were higher than medical institutions in terms of system soundness rate,pre-job training rate,proportion of quality management leaders and full-time(part-time)quality inspectors,setting rate of hand-washing facilities in zones,passages,isolation barriers,dressing(buffer)room,and toilets,configuration rate of hygiene isolation washing equipment,tunnel washing unit,washing equip-ment with heating functions,drying equipment and mechanical ventilation facilities,and specialty machine washing rate.Among 234 medical textiles specimens,11.97％were detected fungi,and the total fungal colonies in 5 clean textiles exceeded 100 CFU/100 cm2.Conclusion WS/T 508-2016 can further standardize the washing and disin-fection of medical textiles in China through strengthening institutional management,improving the supervision level of service providers,perfecting hardware facilities and layout,introducing new technologies,and increasing the mo-nitoring on fungi in clean textiles.

OBJECTIVE To investigate the intervention effect and its potential mechanism of Yifei xuanfei jiangzhuo formula by inhibiting mitochondrial fission in a vascular dementia(VaD)model rats.METHODS VaD rat model was established by bilateral common carotid artery ligation.The experimental animals were randomly divided into sham operation group(SHAM),model group(MOD),Yifei xuanfei jiangzhuo formula low-dose group(YFXF-L),Yifei xuanfei jiangzhuo formula high-dose group(YFXF-H),and Donepezil hydrochloride group(positive control),with 9 animals in each group.After 30 days of intervention,the spatial learning memory ability was assessed by Morris water maze experiment;HE staining was used to observe histopathological changes in CA1 area of hippocampus;ELISA was used to detect the levels of serum inflammatory factors[interleukin-1β(IL-1β)and IL-4];Western blot was used to detect the expressions of heat shock protein 90(HSP90)/mixed lineage kinase domain-like protein(MLKL)/dynamin-related protein 1(Drp1)pathway-related proteins,mitochondrial fusion proteins(MFN1,MFN2),and adenosine triphosphate synthase 5A(ATP5A)in hippocampal tissues.The immunohistochemistry was used to detect the level of phosphorylated MLKL(p-MLKL);real-time fluorescence quantitative PCR was adopted to detect mRNA expressions of HSP90,MFN1,MFN2 and ATP5A.RESULTS Compared with SHAM group,the escape latency of rats in the MOD group was significantly prolonged,the number of crossing the platform was significantly reduced,and the hippocampal tissues showed typical neuronal damage characteristics,the positive expression level of p-MLKL and the serum level of IL-1β significantly increased,while the serum level of IL-4 significantly decreased,the protein and mRNA expression of HSP90,as well as the protein expressions of p-MLKL/MLKL and p-Drp1(Ser616)/Drp1 were all significantly increased in hippocampal tissue,the protein and mRNA expressions of MFN1,MFN2 and ATP5A,and protein expression of p-Drp1(Ser637)/Drp1 were all significantly decreased(P＜0.05).After the intervention of Yifei xuanfei jiangzhuo formula,above indicators in each treatment group were all significantly reversed(P＜0.05).CONCLUSIONS Yifei xuanfei jiangzhuo formula may alleviate neuronal damage and neuroinflammatory responses in VaD rats by regulating the HSP90/MLKL/Drp1 signaling pathway,inhibiting mitochondrial fission,thereby maintaining mitochondrial dynamic balance and improving mitochondrial function.

Objective Objective To explore the effects of Propofol on neuronal autophagy,memory function,and the classical protein kinase Cγ(cPKCγ)-related pathway in the offspring of rats during the second trimester of pregnancy.Methods Thirty-six SD rats at 14 d of gestation were randomly divided into the control group,the Propofol group and the Propofol+cPKCγ inhibitor group,with 12 rats in each group.Ten pregnant mice were randomly selected from each group.The pregnancy continued until the offspring mice were born.The Morris water maze test was performed on the offspring mice at 30-34 d after birth.Western blotting was used to detect microtubule-associated protein light chain 3Ⅱ/Ⅰ(LC3 Ⅱ/LC3 Ⅰ),Beclin-1,cPKCγ and growth-associated protein-43(GAP-43)expression levels in hippocampal tissue,and immunofluorescence was used to determine the expression of autophagy-related protein ATG7 in hippocampal tissue.Results Compared with the control group,the Propofol group and the propofol+cPKCγ inhibitor group showed increased escape latency at 31,32,33 and 34 d after birth(P<0.05),while there was significantly decreased escape latency in the Propofol+cPKCγ inhibitor group,compared with the Propofol group(P<0.05).Compared with the control group,the Propofol group and the Propofol+cPKCγ inhibitor group had significantly decreased number of platform crossings(P<0.05),while there was significantly increased number of platform crossings in the Propofol+cPKCγ inhibitor group,compared with the Propofol group(P<0.05).Compared with the control group,the Propofol group and the Propofol+cPKCγ inhibitor group had increased time spent in quadrant I and decreased time spent in quadrant Ⅱ(P<0.05),while there was decreased time spent in quadrant Ⅰ and increased time spent in quadrant Ⅱ in the Propofol+cPKCγ inhibitor group,compared with the Propofol group(P<0.05).Compared with the control group,the LC3 Ⅱ/LC3 Ⅰratio,and the expression of Beclin-1,cPKCγ,and GAP-43 protein in the hippocampal tissue of offspring rats in the Propofol group and the Propofol+cPKCγ inhibitor group were significantly increased(P<0.05).Compared with the Propofol group,the LC3Ⅱ/LC3Ⅰ ratio,and the expression of Beclin-1,cPKCγ,and GAP-43 protein in the hippocampal tissue of offspring rats in the Propofol+cPKCγ inhibitor group was significantly decreased(P<0.05).Compared with the control group,the expression of ATG7 in the hippocampal tissue of offspring rats in both the Propofol group and the Propofol+cPKCγ inhibitor group was significantly increased(P<0.05).Compared with the propofol group,the expression of ATG7 in the hippocampal tissue of offspring rats in the Propofol+cPKCγ inhibitor group was significantly decreased(P<0.05).Conclusion Propofol can cause cognitive impairment in the offspring of rats during the second trimester of pregnancy,promote neuronal autophagy,and inhibit activation of the cPKCγ/GAP-43 pathway in the hippocampus,which may improve cognitive impairment in the offspring rats.

Objective:To investigate the immune signatures of endometrial carcinoma(EC)patients with POLE mutation.Methods:A total of 104 paraffin-embedded tissue samples of EC were collected from December 2020 to October 2022,including 11 POLE mutants and 93 POLE wild type in Department of Pathology,Taihe Hospital.Immunohistochemistry was conducted to detect ex-pressions of CD4,CD8 and PD-L1 proteins in EC tissue.Combined with TCGA database,bioinformatics was used to analyze immune infiltration of POLE mutants,mainly including CD4,CD8,PD-L1 mRNA expressions and related prognosis analysis.Results:Based on TCGA database analysis,compared to POLE wild type EC,significantly different expression genes,including chemokine family,immune cell surface markers and lysozyme genes(all P<0.05),were revealed in POLE mutants.In POLE mutant samples,main enriched signaling pathways including immune regulation,mesenchymal-epithelial transformation,etc.(all P<0.01).Compared with POLE wild-type,abundance of CD4+T cells,CD8+T cells,M1 macrophages and dendritic cells in EC samples with POLE mutation was sig-nificantly up-regulated(P<0.05).TISIDB platform assay suggested that POLE mutants primarily drove biological behavior of immune cells,including recruitment and activation of dendritic cells,NK cells,T cells and other immune cells,and lymphocyte homing in EC.Additionally,various immunosuppressive genes(including PD-L1,CTLA-4,TIM-3,etc.)were significantly overexpressed in EC with POLE mutants.In clinical samples,it was also confirmed that POLE mutation was significantly correlated with hyper-expressions of CD8,CD4 and PD-L1(all P<0.001).Prognostic analysis of TCGA showed that survival time of CD8 or PD-L1 over-expression of the POLE mutant subgroup was significantly prolonged,while CD8 or PD-L1 down-regulation of POLE wild-type subgroup was the shortest(P<0.01);there was no significant difference in CD4 subgroup(P>0.05).Conclusion:In EC patients,infiltration abun-dance of CD8+T cells and expression of PD-L1 have crucial value for prognosis or treatment of EC patients with POLE mutation.

[Objective]To explore the incremental cost of central line-associated bloodstream infections(CLABSI)after central venous catheterization(CVC)in critically ill patients in the intensive care unit(ICU),as well as the main cost of nosocomial infection prevention and control.By comparing these two costs,the medical personnel to pay more attention should CLABSI prevention and control from the perspectives of medical quality and economic benefits,and promote the implementation of prevention and control measures.[Methods]Cluster sampling was used to select 126 critically ill patients who underwent CVC in the ICU of a tertiary traditional Chinese medicine hospital from January 2021 to December 2023,including 65 cases in the CLABSI group and 61 in the non-CLABSI group.Patients'data were retrospectively collected from the hospital medical records,including the disease type,gender,age,length of hospital stay,outcome,and hospitalization expenses.The costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection were analyzed and compared.[Results]There were significant differences in the length of hospital stay(Z=-5.35,P<0.05)and total hospitalization expenses(Z=-6.79,P<0.05)between the CLABSI and non-CLABSI group.Total hospitalization expenses showed significant differences among patients with different lengths of hospital stay(H=43.01,P<0.05),with much higher median one in those with 60 or more days of hospital stay than other patients.Greater differences of median total hospitalization expenses were found in males than in females(Z=-3.98,P<0.05),as well as in patients aged 60-80 years than in patients of other ages(Z=-5.79,P<0.05).[Conclusions]The occurrence of CLABSI significantly increases the ICU patients'length of hospital stay and hospitalization expenses.There are differences in the costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection,but these costs are acceptable compared to the incremental costs directly attributable to CLABSI.Therefore,medical institutions should attach importance to the investment in prevention and control of nosocomial infections such as hand hygiene and environmental cleaning and disinfection,formulate practical,reasonable and feasible plans,and ensure their implementation,in order to avoid nosocomial infections,improve the medical quality,effectively control patients'length of hospital stay and hospitalization costs,and strive to maintain patient safety.

Objective To evaluate the clinical efficacy of stellate ganglion block(SGB)combined with intranasal dexmedetomidine for the treatment of insomnia.Methods A total of 64 patients aged 18 to 75 with insom-nia were randomly assigned to either the experimental group(DS group)or the control group(S group).The S group received SGB treatment for 14 consecutive days,whereas the DS group received an additional intranasal dexmedeto-midine spray at a dose of 100 μg,administered 30 minutes before bedtime on days 1 through 6,in conjunction with SGB.We measured and recorded the Pittsburgh Sleep Quality Index(PSQI),Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS)scores,and Psychomotor Vigilance Test(PVT)results for both groups at three time points:baseline(T1),the day after treatment(T2),and one month after treatment(T3).Results Intra-group Com-parison:In both the DS and S groups,PSQI scores and dimensionspecific scores at T2 and T3 were significantly lower compared to T1(P<0.05).SAS and SDS scores in both groups showed a significant reduction at T3 compared to T1 and T2(P<0.05),while PVT results exhibited no significant changes(P>0.05).Inter-group Comparison:The PSQI scores and dimensionspecific scores in the DS group at T2(8.44±2.99)and T3(8.22±2.60)were significantly lower than those in the S group at T2(10.88±2.56)and T3(10.88±2.84)(P<0.05).However,no significant differences were observed in SDS and SAS scores between the DS and S groups at T2 and T3(P>0.05).Conclusion Compared to standalone SGB,the combination of SGB with intranasal dexmedetomidine significantly enhances sleep quality in patients with insomnia,while not impacting their levels of anxiety,depression,or alertness.

Objective Objective To explore the effects of Propofol on neuronal autophagy,memory function,and the classical protein kinase Cγ(cPKCγ)-related pathway in the offspring of rats during the second trimester of pregnancy.Methods Thirty-six SD rats at 14 d of gestation were randomly divided into the control group,the Propofol group and the Propofol+cPKCγ inhibitor group,with 12 rats in each group.Ten pregnant mice were randomly selected from each group.The pregnancy continued until the offspring mice were born.The Morris water maze test was performed on the offspring mice at 30-34 d after birth.Western blotting was used to detect microtubule-associated protein light chain 3Ⅱ/Ⅰ(LC3 Ⅱ/LC3 Ⅰ),Beclin-1,cPKCγ and growth-associated protein-43(GAP-43)expression levels in hippocampal tissue,and immunofluorescence was used to determine the expression of autophagy-related protein ATG7 in hippocampal tissue.Results Compared with the control group,the Propofol group and the propofol+cPKCγ inhibitor group showed increased escape latency at 31,32,33 and 34 d after birth(P<0.05),while there was significantly decreased escape latency in the Propofol+cPKCγ inhibitor group,compared with the Propofol group(P<0.05).Compared with the control group,the Propofol group and the Propofol+cPKCγ inhibitor group had significantly decreased number of platform crossings(P<0.05),while there was significantly increased number of platform crossings in the Propofol+cPKCγ inhibitor group,compared with the Propofol group(P<0.05).Compared with the control group,the Propofol group and the Propofol+cPKCγ inhibitor group had increased time spent in quadrant I and decreased time spent in quadrant Ⅱ(P<0.05),while there was decreased time spent in quadrant Ⅰ and increased time spent in quadrant Ⅱ in the Propofol+cPKCγ inhibitor group,compared with the Propofol group(P<0.05).Compared with the control group,the LC3 Ⅱ/LC3 Ⅰratio,and the expression of Beclin-1,cPKCγ,and GAP-43 protein in the hippocampal tissue of offspring rats in the Propofol group and the Propofol+cPKCγ inhibitor group were significantly increased(P<0.05).Compared with the Propofol group,the LC3Ⅱ/LC3Ⅰ ratio,and the expression of Beclin-1,cPKCγ,and GAP-43 protein in the hippocampal tissue of offspring rats in the Propofol+cPKCγ inhibitor group was significantly decreased(P<0.05).Compared with the control group,the expression of ATG7 in the hippocampal tissue of offspring rats in both the Propofol group and the Propofol+cPKCγ inhibitor group was significantly increased(P<0.05).Compared with the propofol group,the expression of ATG7 in the hippocampal tissue of offspring rats in the Propofol+cPKCγ inhibitor group was significantly decreased(P<0.05).Conclusion Propofol can cause cognitive impairment in the offspring of rats during the second trimester of pregnancy,promote neuronal autophagy,and inhibit activation of the cPKCγ/GAP-43 pathway in the hippocampus,which may improve cognitive impairment in the offspring rats.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.