OBJECTIVE To establish drug utilization evaluation （DUE） criteria for pyrotinib to promote its appropriate application in clinical practice. METHODS Based on the label of Pyrotinib maleate tablets， with relevant guiding principles and diagnostic and treatment guidelines as the evaluation basis， DUE criteria for pyrotinib were determined through the Delphi method. Attribute hierarchical model （AHM） and entropy weight method （EWM） were used to combine and assign weights to each indicator within the DUE criteria. Additionally， the weighted technique for order preference by similarity to an ideal solution （TOPSIS） method was applied to perform rationality evaluation of medication in archived medical records from Hainan Provincial Tumor Hospital and Hainan Western Central Hospital regarding the use of pyrotinib from November 2019 to November 2023. RESULTS The established DUE criteria for pyrotinib included 4 primary indicators （prescription authority， indications for use， medication process， and medication outcomes） and 11 secondary indicators. The secondary indicators with higher weights were the route of administration and dosage （0.257） and indications in the label （0.241）. Among the 88 archived cases included， there were 28 cases of inappropriate medication （31.82%）， 43 cases of generally appropriate medication （48.86%）， and 17 cases of appropriate medication （19.32%）. The main issues related to inappropriate medication involved off-label use （42.05%） and inappropriate routes of administration and dosage （43.18%）. CONCLUSIONS DUE criteria for pyrotinib established using the AHM-EWM-weighted TOPSIS method is highly operational and results in quantifiable evaluation outcomes. The overall rationality of the use of pyrotinib in the above hospitals remains to be improved， and there are some issues， like the off-label use，and inappropriate routes of administration and dosage being liaoyylyy@163.com unreasonable.

Objective:To compare the clinical efficacy and safety of different myotomy procedures during peroral endoscopic myotomy (POEM) for achalasia (AC).Methods:A retrospective study was conducted involving patients diagnosed as having achalasia and underwent POEM at Peking Union Medical College Hospital from April 2020 to October 2023. Patients were divided into conventional myotomy group, short myotomy group and full-thickness myotomy group according to myotomy length and depth. Outcomes including operation duration, procedure-related complications, efficacy and incidence of postoperative reflux esophagitis were compared between conventional vs. short, and conventional vs. full-thickness groups.Results:Among 70 patients, 26 underwent conventional myotomy, 19 short myotomy, and 25 full-thickness myotomy. The short myotomy group demonstrated significantly shorter procedure duration (72.89±20.57 min) compared to the conventional group (91.81±36.70 min, t=2.197, P=0.034). There were no statistically significant differences in procedure-related complications [26.3% (5/19) VS 34.6% (9/26), χ2=0.353, P=0.553], treatment efficacy [94.7% (18/19) VS 96.2% (25/26), χ2=0.052, P=0.820], or incidence of postoperative reflux esophagitis [50.0% (5/10) VS 41.7% (5/12), χ2=0.306, P=0.580] between the short and conventional myotomy groups. No statistically significant differences were observed between the conventional and full-thickness myotomy group in procedure duration (99.64±29.13 min VS 91.81±36.70 min, t=0.336, P=0.404), procedure-related complications [28.0% (7/25) VS 34.6% (9/26), χ2=0.259, P=0.611], treatment efficacy [96.0% (24/25) VS 96.2% (25/26), χ2=0.001, P=0.977], or incidence of postoperative reflux esophagitis [35.7% (5/14) VS 41.7% (5/12), χ2=0.022, P=0.883]. Conclusion:Short myotomy POEM achieves comparable efficacy to conventional myotomy with reduced operative time and no increased complication risk. Full-thickness myotomy demonstrates similar efficacy, operative duration, and safety to conventional myotomy.

Objective:To formulate the maintenance and management process of extracorporeal membrane oxygenation (ECMO) equipment for adults and explore its implementation effect, in order to provide reference for clinical nursing.Methods:A historical control study design was used. A total of 60 patients who received ECMO treatment at the Department of Critical Care Medicine of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were selected by convenience sampling method as the research subjects. Among them, 30 patients from January to December 2022 were the control group, and 30 patients from 1 to 12 of 2023 were the observation group. The control group received ECMO treatment using routine methods, while the observation group received ECMO treatment according to the maintenance and management process for adult ECMO equipment. The charging time of the ECMO battery, the completeness of the ECMO equipment, the occurrence rate of ECMO equipment failure, the cleanliness rate of the ECMO equipment surface, and the pre-filling time of the ECMO pipeline were compared between the two groups.Results:The control group included 19 males and 11 females, with an age of (51.34 ± 6.85) years. The observation group comprised 21 males and 9 females, with an age of (50.97 ± 5.39) years. In the observation group, the compliance rate of the ECMO battery standby time was observed to be 100.00% (30/30), while the completeness rate of the equipment ready for use was 96.67% (29/30), and the qualification rate of surface cleanliness of ECMO equipment was 93.33% (28/30), all were superior to 76.67% (23/30), 73.33% (22/30), and 63.33% (19/30) in the control group, and the differences were statistically significant ( χ2 = 5.82, 4.71, 7.95, all P<0.05). The incidence rate of ECMO equipment failure in the observation group was 3.33% (1/30), a rate lower than the control group′s 16.67% (5/30), and the difference was statistically significant ( χ2 = 83.18, P<0.001). The pre-filling time of ECMO circuit in the observation group was (9.56 ± 2.20) min, which was less than the control group′s (13.30 ± 2.76) min, and the difference was statistically significant ( t = 5.79, P<0.001). Conclusions:The formulation and implementation of the process help to improve the standardized operation of ECMO in medical care, so that the ECMO equipment and instruments can be well maintained.

Objective:To formulate the maintenance and management process of extracorporeal membrane oxygenation (ECMO) equipment for adults and explore its implementation effect, in order to provide reference for clinical nursing.Methods:A historical control study design was used. A total of 60 patients who received ECMO treatment at the Department of Critical Care Medicine of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were selected by convenience sampling method as the research subjects. Among them, 30 patients from January to December 2022 were the control group, and 30 patients from 1 to 12 of 2023 were the observation group. The control group received ECMO treatment using routine methods, while the observation group received ECMO treatment according to the maintenance and management process for adult ECMO equipment. The charging time of the ECMO battery, the completeness of the ECMO equipment, the occurrence rate of ECMO equipment failure, the cleanliness rate of the ECMO equipment surface, and the pre-filling time of the ECMO pipeline were compared between the two groups.Results:The control group included 19 males and 11 females, with an age of (51.34 ± 6.85) years. The observation group comprised 21 males and 9 females, with an age of (50.97 ± 5.39) years. In the observation group, the compliance rate of the ECMO battery standby time was observed to be 100.00% (30/30), while the completeness rate of the equipment ready for use was 96.67% (29/30), and the qualification rate of surface cleanliness of ECMO equipment was 93.33% (28/30), all were superior to 76.67% (23/30), 73.33% (22/30), and 63.33% (19/30) in the control group, and the differences were statistically significant ( χ2 = 5.82, 4.71, 7.95, all P<0.05). The incidence rate of ECMO equipment failure in the observation group was 3.33% (1/30), a rate lower than the control group′s 16.67% (5/30), and the difference was statistically significant ( χ2 = 83.18, P<0.001). The pre-filling time of ECMO circuit in the observation group was (9.56 ± 2.20) min, which was less than the control group′s (13.30 ± 2.76) min, and the difference was statistically significant ( t = 5.79, P<0.001). Conclusions:The formulation and implementation of the process help to improve the standardized operation of ECMO in medical care, so that the ECMO equipment and instruments can be well maintained.

Objective:To compare the clinical efficacy and safety of different myotomy procedures during peroral endoscopic myotomy (POEM) for achalasia (AC).Methods:A retrospective study was conducted involving patients diagnosed as having achalasia and underwent POEM at Peking Union Medical College Hospital from April 2020 to October 2023. Patients were divided into conventional myotomy group, short myotomy group and full-thickness myotomy group according to myotomy length and depth. Outcomes including operation duration, procedure-related complications, efficacy and incidence of postoperative reflux esophagitis were compared between conventional vs. short, and conventional vs. full-thickness groups.Results:Among 70 patients, 26 underwent conventional myotomy, 19 short myotomy, and 25 full-thickness myotomy. The short myotomy group demonstrated significantly shorter procedure duration (72.89±20.57 min) compared to the conventional group (91.81±36.70 min, t=2.197, P=0.034). There were no statistically significant differences in procedure-related complications [26.3% (5/19) VS 34.6% (9/26), χ2=0.353, P=0.553], treatment efficacy [94.7% (18/19) VS 96.2% (25/26), χ2=0.052, P=0.820], or incidence of postoperative reflux esophagitis [50.0% (5/10) VS 41.7% (5/12), χ2=0.306, P=0.580] between the short and conventional myotomy groups. No statistically significant differences were observed between the conventional and full-thickness myotomy group in procedure duration (99.64±29.13 min VS 91.81±36.70 min, t=0.336, P=0.404), procedure-related complications [28.0% (7/25) VS 34.6% (9/26), χ2=0.259, P=0.611], treatment efficacy [96.0% (24/25) VS 96.2% (25/26), χ2=0.001, P=0.977], or incidence of postoperative reflux esophagitis [35.7% (5/14) VS 41.7% (5/12), χ2=0.022, P=0.883]. Conclusion:Short myotomy POEM achieves comparable efficacy to conventional myotomy with reduced operative time and no increased complication risk. Full-thickness myotomy demonstrates similar efficacy, operative duration, and safety to conventional myotomy.

Objective:To investigate the effect of methylene blue (MB) on motor dysfunction and its mechanism in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinson's disease (PD) mouse models.Methods:Forty healthy male C57BL/6 mice were randomly divided into 4 groups: control group, model group, low-dose treatment group and medium-dose treatment group ( n=10); PD mouse models were established by intraperitoneal injection of 25 mg/kg/d MPTP for a consecutive 7 d; low-dose treatment group and medium-dose treatment group were pretreated intraperitoneally with MB 2 mg/kg/d or MB 10 mg/kg/d for a consecutive 3 d, respectively; and then, MPTP 25 mg/kg/d+MB 2 mg/kg/d or MPTP 25 mg/kg/d+MB 10 mg/kg/d were injected intraperitoneally into the low-dose treatment group or medium-dose treatment group for a consecutive 7 d (MPTP and MB were given at 12 h of interval). Eight d after modeling, open field experiment, pole climbing experiment and rod rotating experiment were carried out to evaluate the spontaneous movement, coordination, endurance and motor ability. And then, the mice were sacrificed; immunofluorescent staining was used to observe tyrosine hydroxylase (TH) expression in the substantia nigra; Western blotting was used to detect the expressions of TH, α-synuclein, nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain-containing 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC), cleaved-Caspase-1 and Gasdermin D (GSDMD) in the striatum and substantia nigra of mice. Contents of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-18 in the substantia nigra and striatum of mice were detected by ELISA. Results:Compared with the control group, the model group had shortened residence time in rod rotating, prolonged descent time in rod climbing, reduced total movement distance in open field, decreased number of TH-positive cells in the substania nigra, decreased TH protein levels in the substania nigra and striatum, and increased NLRP3, ASC, cleaved-Caspase-1, GSDMD and GSDMD-N protein levels in the substania nigra and striatum, and increased TNF-α, IL-1β and IL-18 contents in the substania nigra and striatum, with significant differences ( P<0.05). Compared with the model group, low-dose treatment group and medium-dose treatment group had prolonged residence time in rod rotating, shortened descent time in rod climbing, increased total movement distance in open field, increased number of TH-positive cells in the substania nigra, and increased TH protein levels in the substania nigra and striatum, decreased NLRP3, ASC, and cleaved-Caspase-1 levels in the substania nigra and striatum, and decreased TNF-α, IL-1β and IL-18 contents in the substania nigra and striatum, with significant differences ( P<0.05). No statistical differences in the above indexes were noted between the low-dose treatment group and medium-dose treatment group ( P>0.05). Conclusion:Low-/medium-dose MB can ameliorate motor dysfunction in PD mouse models, whose mechanism may be related to downregulate NLRP3 inflammasome and inhibit neuroinflammatory response to reduce dopaminergic neuron pyroptosis.

BACKGROUND:Previous studies have reported inconsistent results with positive,negative,and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection(AAD).This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD. METHODS:The UK Biobank study is a population-based cohort study.Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score(GRS).Cox proportional hazards models were used to estimate hazard ratios(HRs)with 95%confidence intervals(CIs)for the associations between alcohol consumption and AAD.Several sensitivity analyses were performed to assess the robustness of the results. RESULTS:Among the 388,955 participants(mean age:57.1 years,47.4%male),2,895 incident AAD cases were documented during a median follow-up of 12.5 years.Compared with never-drinkers,moderate drinkers(adjusted HR:0.797,95%CI:0.646-0.984,P<0.05)and moderate-heavy drinkers(adjusted HR:0.794,95%CI:0.635-0.992,P<0.05)were significantly associated with a decreased risk of incident AAD.Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women. CONCLUSION:Our findings support a protective effect of moderate alcohol consumption on AAD,but are limited to participants younger than 65 years and women.

BACKGROUND:Previous studies have reported inconsistent results with positive,negative,and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection(AAD).This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD. METHODS:The UK Biobank study is a population-based cohort study.Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score(GRS).Cox proportional hazards models were used to estimate hazard ratios(HRs)with 95%confidence intervals(CIs)for the associations between alcohol consumption and AAD.Several sensitivity analyses were performed to assess the robustness of the results. RESULTS:Among the 388,955 participants(mean age:57.1 years,47.4%male),2,895 incident AAD cases were documented during a median follow-up of 12.5 years.Compared with never-drinkers,moderate drinkers(adjusted HR:0.797,95%CI:0.646-0.984,P<0.05)and moderate-heavy drinkers(adjusted HR:0.794,95%CI:0.635-0.992,P<0.05)were significantly associated with a decreased risk of incident AAD.Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women. CONCLUSION:Our findings support a protective effect of moderate alcohol consumption on AAD,but are limited to participants younger than 65 years and women.

BACKGROUND:Previous studies have reported inconsistent results with positive,negative,and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection(AAD).This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD. METHODS:The UK Biobank study is a population-based cohort study.Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score(GRS).Cox proportional hazards models were used to estimate hazard ratios(HRs)with 95%confidence intervals(CIs)for the associations between alcohol consumption and AAD.Several sensitivity analyses were performed to assess the robustness of the results. RESULTS:Among the 388,955 participants(mean age:57.1 years,47.4%male),2,895 incident AAD cases were documented during a median follow-up of 12.5 years.Compared with never-drinkers,moderate drinkers(adjusted HR:0.797,95%CI:0.646-0.984,P<0.05)and moderate-heavy drinkers(adjusted HR:0.794,95%CI:0.635-0.992,P<0.05)were significantly associated with a decreased risk of incident AAD.Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women. CONCLUSION:Our findings support a protective effect of moderate alcohol consumption on AAD,but are limited to participants younger than 65 years and women.

BACKGROUND:Previous studies have reported inconsistent results with positive,negative,and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection(AAD).This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD. METHODS:The UK Biobank study is a population-based cohort study.Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score(GRS).Cox proportional hazards models were used to estimate hazard ratios(HRs)with 95%confidence intervals(CIs)for the associations between alcohol consumption and AAD.Several sensitivity analyses were performed to assess the robustness of the results. RESULTS:Among the 388,955 participants(mean age:57.1 years,47.4%male),2,895 incident AAD cases were documented during a median follow-up of 12.5 years.Compared with never-drinkers,moderate drinkers(adjusted HR:0.797,95%CI:0.646-0.984,P<0.05)and moderate-heavy drinkers(adjusted HR:0.794,95%CI:0.635-0.992,P<0.05)were significantly associated with a decreased risk of incident AAD.Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women. CONCLUSION:Our findings support a protective effect of moderate alcohol consumption on AAD,but are limited to participants younger than 65 years and women.