Objective:To investigate the use of non-vitamin K antagonist oral anticoagulants(NOACs)and their associated comorbidities in patients aged 80 years and older with non-valvular atrial fibrillation(NVAF), as well as to understand the challenges faced by elderly patients receiving NOAC therapy.Methods:We retrospectively enrolled elderly patients(≥80 years old)with NVAF who were treated with NOACs at a hospital in Beijing from January 2018 to August 2023.Patients were categorized into two age groups: 80-89 years and ≥90 years.We collected baseline data, including demographic characteristics, details of atrial fibrillation, comorbidities, laboratory test results, and medication combinations, for descriptive statistical analysis and intergroup comparisons.Results:A total of 695 elderly patients with NVAF receiving NOACs were included in the study, with a median age of 84 years.Among these patients, there were 328 males(47.19%, 328/695)and 422 cases of paroxysmal atrial fibrillation(60.72%, 422/695).The age group of 80-89 years comprised 640 cases(92.09%, 640/695), while the group aged 90 years and above included 55 cases(7.91%, 55/695).The use of NOACs in patients aged 90 and older exhibited an increasing trend over the years.Inter-group comparisons indicated that the ≥90 years group had lower body mass index, longer hospital stays, increased bedridden time, poorer renal function, lower levels of albumin and hemoglobin, and higher D-dimer levels.Inappropriate dosing of DOACs occurred in 49.64%(345/695)of cases, with 90.72%(313/345)receiving doses lower than recommended.Lower-than-recommended doses were more prevalent in the ≥90 years group, while higher-than-recommended doses were more common in the 80-89 years group.Polypharmacy was noted in 61.29%(426/695)of patients.The concurrent use of antiplatelet drugs, rhythm control medications, and ventricular rate control drugs was observed in 12.52%(87/695), 19.57%(136/695), and 54.53%(379/695)of patients, respectively, with no significant differences between groups.Conclusions:Inappropriate dosing and polypharmacy are prevalent issues among elderly NVAF patients.Therefore, it is essential to enhance multidisciplinary collaboration to optimize anticoagulation treatment strategies.

Objective:To compare surgical-related indicators between non-inflated subclavian endoscopic surgery and axillary and traditional open surgery for the treatment of right lobe thyroid cancer,as well as their effects on postoperative anterior cervical function and cosmetic outcomes.Methods:This retrospective cohort study analyzed 151 cases of thyroid cancer patients who underwent surgical treatment at the Department of Thyroid Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2024 to October 2024. Based on the surgical approach,patients were divided into three groups:56 cases of traditional open surgery group, 44 cases of non-inflated axillary approach group,and 51 cases of non-inflated subclavian approach group. Comparative indicators included surgical time, parathyroid autotransplantation rate,complete exposure rate of central area, number of lymph node dissections, number of positive lymph nodes, anterior cervical function, and satisfaction with incision beauty. One-way analysis of variance,non-parametric test,Kruskal-Wallis test,Pearson χ2 test and Fisher′s exact probability method were used to compare the results of the three groups and subsequent pairwise comparisons,respectively. Results:All laparoscopic surgeries were successfully completed without conversion to open surgery. (1) Surgical time:the traditional open surgery group had the shortest operative time ( M(IQR))(71.5(16.0)minutes), significantly shorter than both endoscopic groups (both P<0.01); among the endoscopic approaches, the non-inflated subclavian approach group (97.0(10.0)minutes) had a significantly shorter operative time than the non-inflated axillary approach group (115.0(11.0)minutes)( P<0.01). (2) Parathyroid autotransplantation rate:the rates were 53.6%(30/56) in the traditional group, 70.5%(31/44) in the non-inflated axillary approach group, and 66.7%(34/51) in the non-inflated subclavian approach group, with no statistically significant differences ( P>0.05). (3) Complete exposure rate of the central area:the exposure rate was 100%(56/56) in the traditional open surgery group, 86.4%(38/44) in the non-inflated axillary approach group, and 96.1%(49/51) in the non-inflated subclavian approach group. A significant difference was observed between the traditional open surgery group and the non-inflated axillary approach group ( χ2=8.124, P<0.01), but not observed between other groups. (4) Number of lymph node dissection:no significant difference was found among the three groups (8(6)(range:2 to 17) in the traditional open surgery group,7(3)(range:2 to 16) in the non-inflated axillary approach group,7(4)(range:2 to 16) in the non-inflated subclavian approach group)( P=0.078).(5) Number of positive lymph nodes:no significant differences were observed among the three groups( P=0.923). (6) Postoperative anterior cervical function:① Visual analogue scale: there was no significant difference between the non-insufflation transaxillary approach group and the non-insufflation subclavian approach group at 3 days and 1 month postoperatively ( P>0.017). However, the two groups had significantly lower scores than the traditional open group (both P<0.01). ② Neck disability index:at 3 days post-surgery, there were significantly lower in the axillary and subclavian groups compared to the traditional open group ( P<0.01), with no significant difference between the two endoscopic groups( P>0.017); at 1 month postoperatively, the traditional open surgery group, gasless axillary approach group, and gasless subclavian approach group, with statistically significant differences between each group (both P<0.01). ③ Swallowing disorder index: no significant differences were observed at 3 days post-surgery( P>0.05); however, at 1 month post-surgery, the endoscopic groups showed significantly lower scores compared to the traditional open group(both P<0.01).(7) Satisfaction with incision beauty:significant differences were found among the three groups in terms of vancouver scar scores, patient scar assessment scores, and observer scar assessment scores(all P<0.01). Conclusions:Compared to the non-inflated axillary endoscopic thyroidectomy, the non-inflated subclavian approach offers a technically simpler procedure, better exposure of the central lymph node dissection area, and superior protection of anterior cervical function, although it results in less favorable cosmetic outcomes. Under strict preoperative evaluation and appropriate indications,both non-inflated subclavian and axillary approaches can achieve outcomes comparable to traditional open surgery for cN0 thyroid cancer,demonstrating good clinical application value.

OBJECTIVE To provide practical basis and policy recommendations for improving the pharmacovigilance （PV） system construction in medical institutions across China. METHODS A questionnaire survey was conducted using a mixed sampling strategy of “online random sampling+offline supplementary sampling” to distribute questionnaires among pharmaceutical professionals in tertiary medical institutions nationwide. The questionnaire covered aspects such as the construction of PV systems， job position settings， information system support， operational practices， and multi-stakeholder collaboration. The data were analyzed using descriptive methods and SPSS 20.0 statistical software. RESULTS A total of 70 valid questionnaires were collected from 66 medical institutions， primarily Class A tertiary hospitals. The survey found that 90.00% had designated PV personnel and 74.29% routinely conducted PV activities. However， there were notable disparities in resource allocation and information system capacity， with less than 50% of the institutions conducting post-marketing drug re-evaluation. PV activities were primarily focused on the collection and reporting of adverse drug reactions， with limited capabilities in signal detection and risk assessment. CONCLUSIONS Among the surveyed tertiary hospitals， PV systems have begun to take shape. However， challenges persist in terms of system establishment， resource allocation， risk assessment， and inter-organizational coordination. Policy efforts should focus on strengthening regulatory frameworks， improving information sharing mechanisms， enhancing professional training， and strengthening collaboration between hospitals and market authorization holders to ensure the effective implementation of PV in medical institutions.

OBJECTIVE: To reveal the research status of fire needle by analyzing its patent applications, so as to provide reference for the development of fire needle equipment and the promotion of this therapy. METHODS: By searching the incoPat global patent database, from its inception to December 29th, 2024, the patent data on fire needle was collected. The patent analysis was employed on patent application trends, geographical distribution, patent types, current legal status, applicants and inventors, overall technical composition and distribution of applicable diseases. With the help of incoPat's "shared value" evaluation model, the technical efficacy value of patent was comprehensively measured from 3 dimensions, i.e. technical stability, technological advancement and protection scope. Using SWOT analysis, the matrix of strengths, weaknesses, opportunities and threats of fire needle technique was constructed, and then its development trend was analyzed systematically. RESULTS: A total of 346 patents were included, comprising 23 granted invention patents (6.65%), 219 utility model patents (63.29%), and 157 patents were in an effective state of validity (45.38%). The number of fire needle patent applications showed a growing trend since 2013 and peaked in 2021. The top 3 provinces and cities in terms of the number of applications were Guangdong, Beijing and Shandong. Existing patents focus on improving convenience, reducing complexity, enhancing safety and increasing efficiency; and are specialized in treatment of dermatological diseases. The results of patent research on fire needle show the application of updated materials, invention of equipment and expansion of applicable diseases. However, there are still some limitations such as technical complexity, high cost, lack of composite talents, lack of awareness of patent maintenance and insufficient international promotion. CONCLUSION Multiple strategies are proposed on the development of fire needle therapy, i.e. enhancing financial support and expanding the number of diseases, giving full play to regional characteristics and advantages to promote resource sharing, deepening the integration of industry, research and education to improve the quality of patents, strengthening supervision to reduce low-quality patents, and carrying out high-level research to promote technical standardization and internationalization, and enhance global competitiveness.
Patents as Topic ; Humans ; Acupuncture Therapy/methods* ; Needles ; China

OBJECTIVE To enhance the training quality of anticoagulation specialty clinical pharmacists,address the resource limitations of a single training base,and promote homogenization of training quality.METHODS A multi-base joint training system for anticoagulation specialty clinical pharmacists in the Beijing area was established.A mixed research method was employed,collecting data through performance comparisons,questionnaires,and qualitative interviews to compare the differences between the joint training model(experimental group,n=16)and traditional teaching model(the control group,n=17).RESULTS The established joint training system encompassed a unified joint training teaching plan,the formation of a joint training teaching team,the establishment of joint theoretical teaching courses,the implementation of joint case discussions and literature presentations,as well as strengthening the assessment throughout the joint training process.Compared to the control group[theoretical assessment of(76.44±3.66)points,case assessment of(84.31±3.27)points],the experimental group students achieved higher scores in theoretical assessment[(79.85±4.64)points]and case assessment[(88.70±5.51)points](P＜0.05).Through questionnaires and qualitative interviews,the trainees in experimental group were highly satisfied with the joint training model in terms of theoretical learning,communication skills,and teaching interaction.CONCLUSIONS The multi-base collaborative training system for anticoagulation specialty clinical pharmacists can integrate advantageous resources and significantly enhance the training effectiveness of anticoagulation specialty clinical pharmacists,offering value for wider promotion.

Objective:To investigate the use of non-vitamin K antagonist oral anticoagulants(NOACs)and their associated comorbidities in patients aged 80 years and older with non-valvular atrial fibrillation(NVAF), as well as to understand the challenges faced by elderly patients receiving NOAC therapy.Methods:We retrospectively enrolled elderly patients(≥80 years old)with NVAF who were treated with NOACs at a hospital in Beijing from January 2018 to August 2023.Patients were categorized into two age groups: 80-89 years and ≥90 years.We collected baseline data, including demographic characteristics, details of atrial fibrillation, comorbidities, laboratory test results, and medication combinations, for descriptive statistical analysis and intergroup comparisons.Results:A total of 695 elderly patients with NVAF receiving NOACs were included in the study, with a median age of 84 years.Among these patients, there were 328 males(47.19%, 328/695)and 422 cases of paroxysmal atrial fibrillation(60.72%, 422/695).The age group of 80-89 years comprised 640 cases(92.09%, 640/695), while the group aged 90 years and above included 55 cases(7.91%, 55/695).The use of NOACs in patients aged 90 and older exhibited an increasing trend over the years.Inter-group comparisons indicated that the ≥90 years group had lower body mass index, longer hospital stays, increased bedridden time, poorer renal function, lower levels of albumin and hemoglobin, and higher D-dimer levels.Inappropriate dosing of DOACs occurred in 49.64%(345/695)of cases, with 90.72%(313/345)receiving doses lower than recommended.Lower-than-recommended doses were more prevalent in the ≥90 years group, while higher-than-recommended doses were more common in the 80-89 years group.Polypharmacy was noted in 61.29%(426/695)of patients.The concurrent use of antiplatelet drugs, rhythm control medications, and ventricular rate control drugs was observed in 12.52%(87/695), 19.57%(136/695), and 54.53%(379/695)of patients, respectively, with no significant differences between groups.Conclusions:Inappropriate dosing and polypharmacy are prevalent issues among elderly NVAF patients.Therefore, it is essential to enhance multidisciplinary collaboration to optimize anticoagulation treatment strategies.

Objective:To compare surgical-related indicators between non-inflated subclavian endoscopic surgery and axillary and traditional open surgery for the treatment of right lobe thyroid cancer,as well as their effects on postoperative anterior cervical function and cosmetic outcomes.Methods:This retrospective cohort study analyzed 151 cases of thyroid cancer patients who underwent surgical treatment at the Department of Thyroid Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2024 to October 2024. Based on the surgical approach,patients were divided into three groups:56 cases of traditional open surgery group, 44 cases of non-inflated axillary approach group,and 51 cases of non-inflated subclavian approach group. Comparative indicators included surgical time, parathyroid autotransplantation rate,complete exposure rate of central area, number of lymph node dissections, number of positive lymph nodes, anterior cervical function, and satisfaction with incision beauty. One-way analysis of variance,non-parametric test,Kruskal-Wallis test,Pearson χ2 test and Fisher′s exact probability method were used to compare the results of the three groups and subsequent pairwise comparisons,respectively. Results:All laparoscopic surgeries were successfully completed without conversion to open surgery. (1) Surgical time:the traditional open surgery group had the shortest operative time ( M(IQR))(71.5(16.0)minutes), significantly shorter than both endoscopic groups (both P<0.01); among the endoscopic approaches, the non-inflated subclavian approach group (97.0(10.0)minutes) had a significantly shorter operative time than the non-inflated axillary approach group (115.0(11.0)minutes)( P<0.01). (2) Parathyroid autotransplantation rate:the rates were 53.6%(30/56) in the traditional group, 70.5%(31/44) in the non-inflated axillary approach group, and 66.7%(34/51) in the non-inflated subclavian approach group, with no statistically significant differences ( P>0.05). (3) Complete exposure rate of the central area:the exposure rate was 100%(56/56) in the traditional open surgery group, 86.4%(38/44) in the non-inflated axillary approach group, and 96.1%(49/51) in the non-inflated subclavian approach group. A significant difference was observed between the traditional open surgery group and the non-inflated axillary approach group ( χ2=8.124, P<0.01), but not observed between other groups. (4) Number of lymph node dissection:no significant difference was found among the three groups (8(6)(range:2 to 17) in the traditional open surgery group,7(3)(range:2 to 16) in the non-inflated axillary approach group,7(4)(range:2 to 16) in the non-inflated subclavian approach group)( P=0.078).(5) Number of positive lymph nodes:no significant differences were observed among the three groups( P=0.923). (6) Postoperative anterior cervical function:① Visual analogue scale: there was no significant difference between the non-insufflation transaxillary approach group and the non-insufflation subclavian approach group at 3 days and 1 month postoperatively ( P>0.017). However, the two groups had significantly lower scores than the traditional open group (both P<0.01). ② Neck disability index:at 3 days post-surgery, there were significantly lower in the axillary and subclavian groups compared to the traditional open group ( P<0.01), with no significant difference between the two endoscopic groups( P>0.017); at 1 month postoperatively, the traditional open surgery group, gasless axillary approach group, and gasless subclavian approach group, with statistically significant differences between each group (both P<0.01). ③ Swallowing disorder index: no significant differences were observed at 3 days post-surgery( P>0.05); however, at 1 month post-surgery, the endoscopic groups showed significantly lower scores compared to the traditional open group(both P<0.01).(7) Satisfaction with incision beauty:significant differences were found among the three groups in terms of vancouver scar scores, patient scar assessment scores, and observer scar assessment scores(all P<0.01). Conclusions:Compared to the non-inflated axillary endoscopic thyroidectomy, the non-inflated subclavian approach offers a technically simpler procedure, better exposure of the central lymph node dissection area, and superior protection of anterior cervical function, although it results in less favorable cosmetic outcomes. Under strict preoperative evaluation and appropriate indications,both non-inflated subclavian and axillary approaches can achieve outcomes comparable to traditional open surgery for cN0 thyroid cancer,demonstrating good clinical application value.

OBJECTIVE To know about the perception and current status of drug risk management among pharmacists in Chinese medical institutions,providing insights and recommendations for enhancing the drug risk management system in medical institutions.METHODS A questionnaire survey was conducted across 28 provinces,cities,and autonomous regions;stratified radom sampling was employed to study the population of medical workers and pharmaceutical professionals in medical institutions nationwide.The survey included information on the survey population,the current status of drug risk management implementation in medical institutions,the cognition,definition and process of drug risk management related concepts,and the content and mode of drug risk management work in medical institutions.Finally,suggestions were collected from various medical institutions on the system construction of drug risk management.Descriptive statistical analysis was adopted to summarize the obtained data.RESULTS A total of 446 questionnaires were collected in this survey,including 420 valid questionnaires and 26 invalidquestionnaires.The questionnaire collection rate was 100％,and the effective rate was 94.17％.51.19％ of the respondents based their understanding of drug risk management on Management Measures for Adverse Drug Reaction Reports and Monitoring,while 87.38％ recognized the need for drug risk management throughout the drug use process.63.33％ of the participants stated that their medical institutions had dedicatedpositions related to drug risk management,with the highest proportion (72.17％) was in third-grade class A medical institutions.66.43％ reported implementing risk management across all drug use stages.Suggestions for the development of drug risk management systems in medical institutions by the research participants focused on enhancing guiding documents,clarifying concepts,establishing information-sharing mechanisms.CONCLUSIONS The overall awareness of drug risk management in China's medical institutions is high,with practices in place across various stages in multiple forms.However,there remains a need to strengthen institutional documents,management regulations,system development,and information-sharing mechanisms to improve collaborative governance,improve drug management levels,and ensure patient safety.

Ureterosciatic hernia is a rare type of pelvic floor herniation with no typical symptoms. The resulting ureteral obstruction may lead to hydronephrosis and complications such as urinary tract infection and urosepsis.Fewer than 40 ureterosciatic hernia cases have been reported all over the world. Active surveillance, manual reduction, ureteral stenting and surgical repair are common treatment options. Among them, the safety and effectiveness of laparoscopic herniorrhaphy have been recognized. This article review the advances in the diagnosis and treatment of ureterosciatic hernia.

ObjectiveBased on the new method of animal model evaluation， this paper summarized and analyzed the characteristics of traditional Chinese medicine（TCM） and Western medicine syndromes in existing autism spectrum disorder（ASD） animal models， and put forward suggestions for improvement. MethodRelevant literature on ASD animal models in China National Knowledge Infrastructure（CNKI） and PubMed were searched. According to the diagnostic standards of traditional Chinese and western medicine， core symptoms and accompanying symptoms were assigned values， and the clinical consistency of the models was comprehensively evaluated. ResultMost ASD model experimental animals were rodents， and the modeling methods included genetic and non-genetic. Domestic research focused on biochemical induction， while foreign research used genetic models more commonly. Among all models， valproic acid induction had the highest clinical consistency， followed by the neuroligin 4（NLGN4） and contactin associated protein like 2（CNTNAP2） gene knockout models. Most modeling methods could meet the characteristics of surface validity and structural validity， but did not clearly distinguish TCM syndromes. Currently， there is no model that has a high degree of clinical agreement between TCM and western medicine at the same time. ConclusionThe existing ASD animal models are mostly constructed under the guidance of western medicine， which lacks the characteristics of TCM syndromes. And the selection of evaluation indicators of western medicine is relatively single， without specifying the types of TCM syndromes. It is recommended to apply TCM intervention factors during the process of model preparation， to improve the evaluation indicators of traditional Chinese and western medicine， and to emphasize the study of on non-human primates， so as to lay a solid foundation for future experiments.