Objective To investigate the impact of pharmaceutical services provided by clinical pharmacists on rational drug use and cost control in hepatobiliary surgery under the Diagnosis Related Groups(DRGs)payment model,aming to provide evidence for improving the rationality of drug therapy and saving medical costs.Methods Patients classified under DRGs disease codes HB15,HB13,and HB11 from November 2022 to April 2024 were selected as study subjects.A total of 195 patients were included,with 106 in the intervention group and 89 in the control group.The intervention group received multidimensional clinical pharmaceutical services in addition to the standard care provided to the control group.The rational drug use rate,medication costs,total hospitalization expenses,and length of hospital stay were observed between the two groups.A cost-benefit analysis was employed to evaluate the economic impact of providing pharmaceutical services to hepatobiliary surgical patients.The cost indicator was the clinical pharmacy services cost,and the benefit indicators were the reductions in total hospitalization expenses and medication costs.The benefit-cost ratio(B/C)was calculated,and sensitivity analysis was performed.Results The intervention group showed significantly higher rational use rates of prophylactic antimicrobial agents(drug selection:83.96％vs.46.07％,P＜0.01;treatment duration:84.91％vs.56.18％,P＜0.01)and parenteral nutrition drugs(97.17％vs.73.03％,P＜0.01)compared to the control group.Additionally,the intervention group had significantly reduced the length of hospital stay,total hospitalization expenses,medication costs,and insurance over-expenditure compared to the control group(P＜0.05).Furthermore,clinical pharmacist intervention led to a reduction in medication costs by 4 320.05(2 555.00,5 088.25)yuan(CNY)and total hospitalization expenses by 8 891.12(5 135.05,10 074.03)yuan(CNY).The B/C ratios were 14.24(8.42,16.77)and 29.30(16.92,33.20),respectively,indicating economic efficiency.Sensitivity analysis supported these results.Conclusion Under the DRGs payment model,clinical pharmaceutical services guided by drug therapy pathways contribute to improving rational drug use in hepatobiliary surgery and provide clear economic benefits,playing a positive role in reducing medical costs.

Objective To investigate the impact of pharmaceutical services provided by clinical pharmacists on rational drug use and cost control in hepatobiliary surgery under the Diagnosis Related Groups(DRGs)payment model,aming to provide evidence for improving the rationality of drug therapy and saving medical costs.Methods Patients classified under DRGs disease codes HB15,HB13,and HB11 from November 2022 to April 2024 were selected as study subjects.A total of 195 patients were included,with 106 in the intervention group and 89 in the control group.The intervention group received multidimensional clinical pharmaceutical services in addition to the standard care provided to the control group.The rational drug use rate,medication costs,total hospitalization expenses,and length of hospital stay were observed between the two groups.A cost-benefit analysis was employed to evaluate the economic impact of providing pharmaceutical services to hepatobiliary surgical patients.The cost indicator was the clinical pharmacy services cost,and the benefit indicators were the reductions in total hospitalization expenses and medication costs.The benefit-cost ratio(B/C)was calculated,and sensitivity analysis was performed.Results The intervention group showed significantly higher rational use rates of prophylactic antimicrobial agents(drug selection:83.96％vs.46.07％,P＜0.01;treatment duration:84.91％vs.56.18％,P＜0.01)and parenteral nutrition drugs(97.17％vs.73.03％,P＜0.01)compared to the control group.Additionally,the intervention group had significantly reduced the length of hospital stay,total hospitalization expenses,medication costs,and insurance over-expenditure compared to the control group(P＜0.05).Furthermore,clinical pharmacist intervention led to a reduction in medication costs by 4 320.05(2 555.00,5 088.25)yuan(CNY)and total hospitalization expenses by 8 891.12(5 135.05,10 074.03)yuan(CNY).The B/C ratios were 14.24(8.42,16.77)and 29.30(16.92,33.20),respectively,indicating economic efficiency.Sensitivity analysis supported these results.Conclusion Under the DRGs payment model,clinical pharmaceutical services guided by drug therapy pathways contribute to improving rational drug use in hepatobiliary surgery and provide clear economic benefits,playing a positive role in reducing medical costs.

Objective:To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle.Methods:The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System.Results:Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases.Conclusions:According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.

Objective:To discuss the influence of high load and weightlessness environment on intervertebral disc by observing and analyzing the imaging changes of the spines in New Zealand white rabbits and the content changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) in the intervertebral disc under high load and weightlessness environment, and to provide theoretical basis for prevention and delay of lumbar intervertebral disc degeneration under high load and weightlessness environment.Methods:A total of 120 New Zealand white rabbits with balanced age and body weight were randomly and averagely divided into control groups (further grouped by 30 d, 60 d and 90 d) and high load/weightlessness groups (further grouped by 30 d, 60 d and 90 d) with residual single-blind method. High load was simulated by animal centrifuge and weightlessness was simulated by tail suspension. The imaging changes and the positive expression rates of MMP1, MMP3 and TIMP1 in intervertebral disc were detected, and the statistical differences between the high load/weightlessness group and the control group in different time periods were compared, as well as among the different exposure time in load/weightlessness groups.Results:From the imaging observation, the T2-weighted images of lumbar 6 sacral 1 intervertebral disc in experimental animals decreased to some extent. The positive rates of MMP1 and MMP3 in each high load/weightlessness group were higher than those in the control group for the same exposure time, and the differences were statistically significant ( t=22.97-145.51,all P<0.001). The positive rates of MMP1 and MMP3 increased with the extension of exposure time, and there were statistically differences among the groups with different exposure time in high load/weightlessness group ( F=2531.10, 1758.80, both P<0.001). The positive rate of TIMP1 in each high load/weightlessness group was higher than that in the control group for the same exposure time, and the difference was statistically significant ( t=29.34-65.05, all P<0.001). There was statistically difference on TIMP1 positive rate among different load/weightlessness exposure time groups ( F=462.20, P<0.001). Conclusions:High load/weightlessness can cause the MMP1, MMP3 and TIMP1 content changes in animal lumbar disc. The changes of TIMP1 are obvious in the early stage and the sensitivity is decreased in the late stage. High load/weightlessness may lead to changes in the contents of MMP and TIMP in intervertebral discs, which may accelerate intervertebral disc degeneration.

Objective:To discuss the influence of high load and weightlessness environment on intervertebral disc by observing and analyzing the imaging changes of the spines in New Zealand white rabbits and the content changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) in the intervertebral disc under high load and weightlessness environment, and to provide theoretical basis for prevention and delay of lumbar intervertebral disc degeneration under high load and weightlessness environment.Methods:A total of 120 New Zealand white rabbits with balanced age and body weight were randomly and averagely divided into control groups (further grouped by 30 d, 60 d and 90 d) and high load/weightlessness groups (further grouped by 30 d, 60 d and 90 d) with residual single-blind method. High load was simulated by animal centrifuge and weightlessness was simulated by tail suspension. The imaging changes and the positive expression rates of MMP1, MMP3 and TIMP1 in intervertebral disc were detected, and the statistical differences between the high load/weightlessness group and the control group in different time periods were compared, as well as among the different exposure time in load/weightlessness groups.Results:From the imaging observation, the T2-weighted images of lumbar 6 sacral 1 intervertebral disc in experimental animals decreased to some extent. The positive rates of MMP1 and MMP3 in each high load/weightlessness group were higher than those in the control group for the same exposure time, and the differences were statistically significant ( t=22.97-145.51,all P<0.001). The positive rates of MMP1 and MMP3 increased with the extension of exposure time, and there were statistically differences among the groups with different exposure time in high load/weightlessness group ( F=2531.10, 1758.80, both P<0.001). The positive rate of TIMP1 in each high load/weightlessness group was higher than that in the control group for the same exposure time, and the difference was statistically significant ( t=29.34-65.05, all P<0.001). There was statistically difference on TIMP1 positive rate among different load/weightlessness exposure time groups ( F=462.20, P<0.001). Conclusions:High load/weightlessness can cause the MMP1, MMP3 and TIMP1 content changes in animal lumbar disc. The changes of TIMP1 are obvious in the early stage and the sensitivity is decreased in the late stage. High load/weightlessness may lead to changes in the contents of MMP and TIMP in intervertebral discs, which may accelerate intervertebral disc degeneration.

Alzheimer′s disease (AD) is an incurable disease in the field of major chronic diseases. Subjective cognitive decline (SCD) is a clinical risk factor for AD. The standardized screening and intervention in individuals with SCD are of great importance in early prevention and treatment of AD. According to the clinical criteria proposed by The characterisation of subjective cognitive decline, which was published online in Lancet Neurology, the article summarized the definition of SCD, the latest perspective of clinical standards in SCD, and the results of AD preclinical SCD research. The purpose of this work was to provide concrete guidance and recommendations for making clinical decisions in diagnosis and scientific research on SCD.

Objective: To explore the effects of ApoE epsilon4 (ApoE-ε4) alleles on cognitive function and resting-state functional MRI (rs-fMRI) in patients with amnestic mild cognitive impairment(aMCI) based on a prospective cohort study. Methods: An average of 20 months of prospective observations were conducted on 16 ApoE-ε4-carriers and 24 non-carriers of aMCI. Neuropsychological assessments and rs-fMRI data were collected at both baseline and follow-up. All participants were assessed by a battery of neuropsychological tests and underwent rs-fMRI. Two core regions of the default mode network (DMN), the left posterior cingulate cortex (PCC) and the medial prefrontal cortex (mPFC), were selected as seeds to calculate the functional connectivity. Two-way repeated measures analysis of variance was used to assess the effects of ApoE genotype(ε4-carriers, nonε4-carriers), interval and the interaction between these two factors for functional connectivity extracted from changed region found by t-test.Conversion rates of dementia were compared between ApoE-ε4-carriers and nonε4-carriers at follow-up using Chi-square test. For the comparison of functional connectivity and clinical data between ApoE-ε4-carriers and nonsε4-carriers in baseline and follow-up, the normal distribution test was carried out first. If the normal distribution was fitted, the two-sample t test was used, otherwise, the Mann-Whitney rank sum test was used. Finally, the general linear model was used to assess the relationships between alterations in functional connectivity and in neuropsychological assessments as well as the interaction effect. Results: (1)Significant decline in memory domains were found in ApoE-ε4-carriers as compared to non-carriers at both baseline and follow-up. The ApoE-ε4-carriers (14/16) presented a higher conversation rate than non-carriers(13/24, χ²=4.862, P=0.027) at follow-up. (2)Functional imaging analysis revealed that ApoE-ε4-carriers exhibited significantly higher functional connectivity between the left PCC and the left angular (ApoE-ε4-carriers: 0.23±0.11, non-carriers: -0.03±0.13, t=4.800, cluster size: 1 944 mm³, P=0.004), and between the left mPFC and the left angular (ApoE-ε4-carriers: 0.33±0.21, non-carriers: 0.08±0.18, t=5.040, cluster size:1 836 mm³, P=0.006) as compared to non-carriers at follow-up. We detected significant effect for the interaction interval by ApoE-ε4 on functional connectivity between the left angular and the left PCC (F=10.833, P=0.002)as well as the left mPFC (F=7.280, P=0.010). (3)The alteration of functional connectivity value between the left mPFC and the left angular in ApoE-ε4-carriers was positively correlated with the changes ofimmediate memory (r=0.692, P=0.018). The correlation was not statistically significant in ApoE-ε4-noncarriers (r=-0.198, P=0.417) and the integration effect was significant (F=8.632, P=0.006). Conclusions The ApoE-ε4 actually accelerates the deterioration of cognitive function in aMCI patients and carriers presented relatively reserved functional connectivity between the left angular and other core regions within DMN, which indicated the disruption of functional connectivity may be one of the underline mechanisms of ApoE-ε4 during AD process.