To explore the scoring level and related factors of autoimmune disease-related skin ulcers by collecting data from multiple centers, and to provide ideas and references for targeted intervention measures and management plans for clinical medical and nursing staff.

Objective To investigate the impact of smoking cessation on high-resolution compu-ted tomography(HRCT)phenotypes in smokers with chronic obstructive pulmonary disease(COPD)and its relationship with the frequency of acute exacerbations.Methods A retrospective study was conducted in 237 smokers with COPD who could cooperate with a 1-year follow-up.Among them,160 patients underwent a comprehensive 1-year smoking cessation intervention,and were divided into smoking cessation failure group(87 patients)and smoking cessation success group(73 patients)based on whether they successfully quited smoking.The remaining 77 smokers with COPD who did not receive smoking cessation intervention were designated as smoking group.HRCT phenotypes,total lung volume(TLV),total emphysema volume(TEV),emphysema index(EI)and the number of acute exacerbation at different time points were compared among the three groups.Pearson correlation analysis was used to explore the correlation between smoking cessation and the number of acute exac-erbations.Results There was no statistically significant difference in the proportion of A phenotype patients among the three groups before intervention and at 3 and 6 months of intervention(P＞0.05).At the 9th and 12th months of intervention,the proportion of patients with A phenotype in the smoking group was lower than that in the smoking cessation failure group and smoking cessation success group(P＜0.05).Before the intervention and at the 3rd,6th and 9th months of interven-tion,there were no statistically significant differences in the proportion of patients with E phenotype among the three groups(P＞0.05).Before intervention and at the 3rd and 6th months of interven-tion,there were no statistically significant differences in the proportion of patients with M phenotype among the three groups(P＞0.05).At the 9th and 12th months of intervention,the proportion of patients with M phenotype in the smoking group was higher than that in the smoking cessation failure group and smoking cessation success group(P＜0.05).Before intervention,there were no statisti-cally significant differences in TLV,TEV and EI among the three groups(P＞0.05).One year af-ter the intervention,TLV,TEV and El in the smoking cessation failure group and smoking cessation success group were lower than those in the smoking group(P＜0.05).At the 3rd,6th,9th and 12th months of intervention,the number of acute exacerbations in the the smoking cessation failure group and smoking cessation success group was less than that in the smoking group(P＜0.05).At the 9th and 12th months of intervention,the number of acute exacerbation in the smoking cessation success group was less than that in the smoking cessation failure group(P＜0.05).The results of Pearson correlation analysis showed that smoking cessation was negatively correlated with the number of acute exacerbation in smokers with COPD(P＜0.05),and this negative correlation gradually in-creased with the extension of smoking cessation duration.Conclusion Smoking cessation can im-prove HRCT phenotypes and effectively reduce the number of acute exacerbation in smokers with COPD.

Objective:To construct an evaluation index system for the development of compact county medical communities, so as to provide evaluation tools for promoting the high-quality development of county medical communities in China.Methods:Based on the evaluation criteria and monitoring system related policy documents for the construction of county medical communities released at the national level, an evaluation index system for compact county medical community development was constructed through policy text analysis and expert discussions. The system was applied to evaluate the construction of medical communities in Shaxian County of Fujian Province, A County of Shanxi Province, and B County of Yunnan Province.Results:The evaluation index system included four primary indicators: responsibility community, management community, service community, and interest community, covering 11 secondary indicators and 32 tertiary indicators. The evaluation results showed that the construction level of the compact county medical community in Shaxian County (91.3 points) was slightly higher than that of A County and B County (83.1 and 83.9 points), and its advantages were mainly reflected in management community and interest community. There was still room for improvement in the construction of compact medical communities in all three regions.Conclusions:The evaluation system in this study combined scientific rigor and practical guidance value. It could provide guidance for promoting the construction of compact county medical communities in various regions of China, and provide a basis for relevant policy formulation and optimization.

Enhancing the antimicrobial stewardship level is an important issue in curbing the development and spread of microbial resistance as well as maintaining the health of the people.This study reviews the current situa-tion of antimicrobial application both in China and abroad,sorts out the history of antimicrobial management,finds out the existing problems in the current work,and puts forward measures including attaching importance to patho-gen detection,improving the infection control strategy for antimicrobial-resistant organisms,establishing a multile-vel service mechanism,forming a multidisciplinary core team,and perfecting the management system,so as to pro-vide references for actively responding to the challenges posed by antimicrobial resistance.

Objective To investigate the expression of serum levels of small mothers against decapentaplegic homolog 2(SMAD2)and tumor necrosis factor receptor-related associated factor 3(TRAF3)in patients with lupus nephritis(LN)and their correlation with prognosis.Methods A total of 150 patients with LN(LN group)and 80 patients with systemic lupus erythema-tosus(SLE)without nephritis(non-LN group)treated at Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to March 2023 were selected.Patients with LN were followed up for 1 year and divided into the poor progno-sis group(n=61)and the good prognosis group(n=89).Serum levels of SMAD2 and TRAF3 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate unconditional logistic regression was used to identify factors affecting poor progno-sis in LN patients,and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of se-rum SMAD2 and TRAF3 levels for LN prognosis.Results Compared with the non-LN group,serum SMAD2(5.34±1.16ng/ml vs 2.98±1.11ng/ml)and TRAF3(91.23±12.58ng/L vs 74.38±11.91ng/L)levels were significantly elevated in the LN group,and the differences were statistically significant(t=14.917,9.852,all P＜0.05).During the 1-year follow-up,the incidence of poor prognosis among the 150 LN patients was 40.67%(61/150).Compared with the good prognosis group,serum SMAD2(6.03±1.02ng/ml vs 4.86±1.00ng/ml)and TRAF3(98.65±10.49ng/L vs 86.15±11.35ng/L)levels were significantly higher in the poor prognosis group,and the differences were statistically significant(t=7.015,6.830,all P＜0.05).The independent risk factors for poor prognosis in LN patients were advanced chronic kidney disease stage,elevated SMAD2 and elevated TRAF3,while the independent protective factor was increased estimated glomerular filtration rate(eGFR)(Wald χ2=9.633～16.666,all P＜0.05).The area under the curve(AUC)of predicting poor prognosis in LN patients by serum SMAD2 and TRAF3 levels was larger than that predicted by serum SMAD2 alone and TRAF3 levels alone,and the differences were statistically significant(Z=3.658,3.606,all P＜0.05).Conclusion Elevated serum SMAD2 and TRAF3 levels in LN patients are closely associated with poor prognosis.The combination of serum SMAD2 and TRAF3 levels has high predictive efficacy for poor prognosis in LN patients.

Objective To investigate the expression of serum levels of small mothers against decapentaplegic homolog 2(SMAD2)and tumor necrosis factor receptor-related associated factor 3(TRAF3)in patients with lupus nephritis(LN)and their correlation with prognosis.Methods A total of 150 patients with LN(LN group)and 80 patients with systemic lupus erythema-tosus(SLE)without nephritis(non-LN group)treated at Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to March 2023 were selected.Patients with LN were followed up for 1 year and divided into the poor progno-sis group(n=61)and the good prognosis group(n=89).Serum levels of SMAD2 and TRAF3 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate unconditional logistic regression was used to identify factors affecting poor progno-sis in LN patients,and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of se-rum SMAD2 and TRAF3 levels for LN prognosis.Results Compared with the non-LN group,serum SMAD2(5.34±1.16ng/ml vs 2.98±1.11ng/ml)and TRAF3(91.23±12.58ng/L vs 74.38±11.91ng/L)levels were significantly elevated in the LN group,and the differences were statistically significant(t=14.917,9.852,all P＜0.05).During the 1-year follow-up,the incidence of poor prognosis among the 150 LN patients was 40.67%(61/150).Compared with the good prognosis group,serum SMAD2(6.03±1.02ng/ml vs 4.86±1.00ng/ml)and TRAF3(98.65±10.49ng/L vs 86.15±11.35ng/L)levels were significantly higher in the poor prognosis group,and the differences were statistically significant(t=7.015,6.830,all P＜0.05).The independent risk factors for poor prognosis in LN patients were advanced chronic kidney disease stage,elevated SMAD2 and elevated TRAF3,while the independent protective factor was increased estimated glomerular filtration rate(eGFR)(Wald χ2=9.633～16.666,all P＜0.05).The area under the curve(AUC)of predicting poor prognosis in LN patients by serum SMAD2 and TRAF3 levels was larger than that predicted by serum SMAD2 alone and TRAF3 levels alone,and the differences were statistically significant(Z=3.658,3.606,all P＜0.05).Conclusion Elevated serum SMAD2 and TRAF3 levels in LN patients are closely associated with poor prognosis.The combination of serum SMAD2 and TRAF3 levels has high predictive efficacy for poor prognosis in LN patients.

Enhancing the antimicrobial stewardship level is an important issue in curbing the development and spread of microbial resistance as well as maintaining the health of the people.This study reviews the current situa-tion of antimicrobial application both in China and abroad,sorts out the history of antimicrobial management,finds out the existing problems in the current work,and puts forward measures including attaching importance to patho-gen detection,improving the infection control strategy for antimicrobial-resistant organisms,establishing a multile-vel service mechanism,forming a multidisciplinary core team,and perfecting the management system,so as to pro-vide references for actively responding to the challenges posed by antimicrobial resistance.

Objective:To construct an evaluation index system for the development of compact county medical communities, so as to provide evaluation tools for promoting the high-quality development of county medical communities in China.Methods:Based on the evaluation criteria and monitoring system related policy documents for the construction of county medical communities released at the national level, an evaluation index system for compact county medical community development was constructed through policy text analysis and expert discussions. The system was applied to evaluate the construction of medical communities in Shaxian County of Fujian Province, A County of Shanxi Province, and B County of Yunnan Province.Results:The evaluation index system included four primary indicators: responsibility community, management community, service community, and interest community, covering 11 secondary indicators and 32 tertiary indicators. The evaluation results showed that the construction level of the compact county medical community in Shaxian County (91.3 points) was slightly higher than that of A County and B County (83.1 and 83.9 points), and its advantages were mainly reflected in management community and interest community. There was still room for improvement in the construction of compact medical communities in all three regions.Conclusions:The evaluation system in this study combined scientific rigor and practical guidance value. It could provide guidance for promoting the construction of compact county medical communities in various regions of China, and provide a basis for relevant policy formulation and optimization.

Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death(DBD)donors complicated with acute kidney injury(AKI).Methods Clinical data of 216 DBD donors were retrospectively analyzed,and they were divided into the AKI group(n=69)and control group(n=147)according to the Kidney Disease:Improving Global Outcomes(KDIGO)guidelines.Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups.One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group.Postoperative recovery of renal function and clinical outcomes of the recipients were recorded.The risk factors of delayed graft function(DGF)were identified.Results The highest serum creatinine(Scr)level,Scr level before procurement,the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group.The application duration of vasopressors in the AKI group was longer than that in the control group.In the AKI group,the amount of fluid resuscitation within 48 h was higher,the HCO3-level at admission was lower,and the incidence of diabetes insipidus and hypotension was higher than those in the control group.The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts(all P＜0.05).Compared with the control group,the incidence of DGF and acute rejection was higher,the proportion of continuous renal replacement therapy was higher,the Scr level within postoperative 90 d was higher,and the urine amount within postoperative 3 d was less than those of recipients in the AKI group.Compared with KDIGO stage 1 recipients,KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3,4,5 and 15 d,and less urine amount at postoperative 2 d(all P＜0.05).Univariate analysis showed that donor age,the highest Scr level,the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation.Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation(all P＜0.05).Conclusions For the application of DBD donors complicated with AKI,active organ maintenance should be performed to alleviate AKI.It exerts no effect upon graft function and survival rate at postoperative 6 months,which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.

ObjectiveTo explore the potential mechanism of different processed products of Baiyaojian and its compound Xiangmei pills in rats with ulcerative colitis（UC） by comparing the pharmacodynamic and metabolomic differences. MethodEighty SD rats were acclimatized and kept for 3 d， and randomly divided into 8 groups［blank group， model group， mesalazine group（0.4 g·kg^-1）， Baiyaojian group（1.89 g·kg^-1）， stir-fried Baiyaojian group（1.89 g·kg^-1）， carbonized Baiyaojian group（1.89 g·kg^-1）， and Xiangmei pills low and high dose groups（1.89， 5.67 g·kg^-1）］， with 10 rats in each group. Rats in the blank group were administered physiological saline by gavage， and rats in the remaining 7 groups were orally administered 5% dextran sodium sulfate（DSS） solution daily for 8 consecutive days to induce UC model. After successful modeling， each dosing group was given the corresponding dose of drug solution by gavage， and the blank and model groups were given equal amounts of saline by gavage， and the drug was administered continuously for 8 d. Then serum levels of tumor necrosis factor-α（TNF-α）， interleukin（IL）-6， IL-10 and IL-1β were measured by enzyme-linked immunosorbent assay（ELISA）， hematoxylin-eosin（HE） staining was used to observe the histopathological changes of colon tissue， the proportion of T helper 17 cells（Th17） and regulatory T cells（Treg） in the peripheral blood of rats in each group was detected by flow cytometry. The endogenous metabolites in serum of rats were detected by ultra performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry（UPLC-Q-Exactive Orbitrap MS）， and the differential metabolites were characterized by combining principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， and were analyzed according to the variable importance in the projection（VIP） value>1.0 and P<0.05， and potential metabolic pathways were analyzed according to Human Metabolome Database（HMDB）. ResultCompared with the blank group， the colon tissue of the model group was congested and the mucosa was ulcerated， the colon length was significantly reduced（P<0.01） and the quality was significantly increased（P<0.05）， the proportion of Th17/Treg in the peripheral blood and the serum levels of TNF-α， IL-6 and IL-1β were significantly increased， while the IL-10 expression wassignificantly reduced（P<0.05， P<0.01）. Compared with the model group， the colon tissue of UC rats in each treatment group was improved with scattered ulcers， reduced inflammatory cell infiltration， significantly increased colon length， and significantly decreased mass（P<0.05）， the proportion of Th17/Treg in the peripheral blood decreased， the expression of TNF-α，IL-6 and IL-1β was significantly reduced（P<0.05， P<0.01）， while the IL-10 expression was significantly increased（P<0.01）. The therapeutic effect of different administration groups on UC was in the order of high dose group of Xiangmei pills>low dose group of Xiangmei pills>carbonized Baiyaojian group>stir-fried Baiyaojian group>Baiyaojian group. And a total of 26 differential metabolites were screened in the metabolomics results. Compared with the blank group， 14 differential metabolites were up-regulated and 5 metabolites were down-regulated in the model group， and 14， 9， 14， 12 and 17 metabolites could be recalled in the Baiyaojian group， stir-fried Baiyaojian group， carbonized Baiyaojian group， Xiangmei pills low and high dose groups. The main metabolic pathways involved were citrate cycle pathway， pantothenic acid and coenzyme A biosynthesis pathway， aromatic hydrocarbon receptor（AhR） signaling pathway， glycolysis/gluconeogenesis pathway. ConclusionThe therapeutic effect of Baiyaojian on UC is significantly improved after charcoal stir-frying， and the efficacy is more prominent when combined with Angelicae Dahuricae Radix and Mume Fructus Carbonisata， which can provide a basis for the development of Baiyaojian compound preparations.