Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Food enzymology and enzyme engineering is an important professional course of food science. The course includes the basic theory of enzymology, enzyme engineering technology and the application of enzymes in food industry. Considering the knowledge gap between the teaching contents and the cutting-edge researches, the team constantly adjusted and optimized the course contents to enable students to keep up with state-of-the-art progress by carefully mining the cutting-edge researches. Taking cutting-edge researches as the breakthrough point, we explored the problem-based learning (PBL) teaching model under the guidance of outcome-based education (OBE) concept, and highlighted the importance of the teacher-student and student-student interactions to improve students' enthusiasm and participation. A diversified assessment system was established to evaluate the performance of students in the learning process. The teaching reform consolidated the basic knowledge and expanded the academic frontiers, and fostered students' ability in analyzing problems, designing solutions and achieving team communication. The course may give new insights into the teaching reform of food enzymology and enzyme engineering and other related courses.
Humans ; Students ; Learning

OBJECTIVE：To interpret the key points in local standard Specification for Pharmacy Intravenous Centralized Admixture（DB11/T 1701-2019）（Beijing Local Standard for short ）in Beijing ，and to provide guidance and reference for managers of medical institutions and staff of PIVAS to deeply understand the standard and further improve the quality of PIVAS in medical institutions. METHODS ：The background and main content of Beijing Local Standard were interpreted in detail ，and then compared with Quality Specification of Pharmacy Intravenous Admixture （National Specification for short ）promulgated by Chinese National Ministry of Public Health and Quality Specification of Pharmacy Intravenous Admixture Services of Guangdong Provincial （Trial）（Specification of Guangdong Province for short ）promulgated by Guangdong Pharmaceutical Association. RESULTS & CONCLUSIONS：Beijing Local Standard had been promulgated and implemented by Beijing Municipal Administration for Market Regulation on April 1st，2020. The text of Beijing Local Standard is divided into 7 parts，mainly including the scope of application，normative references ，terms and definitions ，basic requirement ，environmental requirements （design，location， layout），equipment and facilities （ventilation system and console ，operation and maintenance ），and admixture requirements. Beijing Local Standard further refines the relevant contents on the basis of following the requirements of National Specification . Like Specification of Guangdong Province ，the applicability and operability of the standard are enhanced by combining their local characteristics and practice status. As the first local standard in this domain ，the local standard is expected to promote the improvement of the working quality of PIVAS in Beijing ，enable the PIVAS of proposed construction ，under construction and operation maintenance to meet uniform standards and reduce the failure of acceptance or reconstruction after completion.

Two patients with eyelid defect were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University.Case 1 was a 45-year-old male with full layer eyelid defect after operation of lower eyelid pigment basal cell carcinoma. And case 2, male, 84 years old, had full eyelid defect after operation of recurrent basal cell carcinoma. A 3.0 cm×3.5 cm mucoperiosteal composite flap was designed in the longitudinal radian of the anterior and posterior palatal respectively. The flap was cut obtuse and sharp under the periosteum, and trimmed according to the shape of the eyelid defect. The flap was transplanted to the defect area of the posterior layer to replace the tarsus, palpebral and bulbar conjunctiva. The superficial outlet point of the zygomatic orbital-buccal lateral perforator vessels was explored before surgery, and the perforator flap was designed. The length and width of the flap were adjusted according to the eyelid defect during surgery, and the pedicle fascia perforator vessels were retained. The lower eyelid was 90°, and the upper eyelid was transferred nearly 100° to cover the outer skin and soft tissue defects of the upper and lower eyelids. The perforator flap was completely survived 9-12 days after the operation. After 8 months to 2 years and 8 months of follow-up, the upper and lower eyelid function and appearance were good, the original vision was maintained, and the cancer did not recur.

Two patients with eyelid defect were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Anhui Medical University.Case 1 was a 45-year-old male with full layer eyelid defect after operation of lower eyelid pigment basal cell carcinoma. And case 2, male, 84 years old, had full eyelid defect after operation of recurrent basal cell carcinoma. A 3.0 cm×3.5 cm mucoperiosteal composite flap was designed in the longitudinal radian of the anterior and posterior palatal respectively. The flap was cut obtuse and sharp under the periosteum, and trimmed according to the shape of the eyelid defect. The flap was transplanted to the defect area of the posterior layer to replace the tarsus, palpebral and bulbar conjunctiva. The superficial outlet point of the zygomatic orbital-buccal lateral perforator vessels was explored before surgery, and the perforator flap was designed. The length and width of the flap were adjusted according to the eyelid defect during surgery, and the pedicle fascia perforator vessels were retained. The lower eyelid was 90°, and the upper eyelid was transferred nearly 100° to cover the outer skin and soft tissue defects of the upper and lower eyelids. The perforator flap was completely survived 9-12 days after the operation. After 8 months to 2 years and 8 months of follow-up, the upper and lower eyelid function and appearance were good, the original vision was maintained, and the cancer did not recur.

Objective To investigate the correlation between the rate of pathological complete response (pCR) and prognostic nutritional index (PNI) in gastric cancer patients who underwent neoadjuvant chemotherapy (NAC). Methods A total of 278 advanced gastric cancer patients who underwent NAC and R0 gastrectomy with D2 lymphadenectomy between January 2012 and March 2017 at the Affiliated Tumor Hospital of Zhengzhou University were analyzed retrospectively. Propensity score matching (PSM) was conducted to reduce the confounding bias between the groups (PNI＜45, 157 patients; PNI≥45, 121 patients). Multivariate analysis was used to determine the independent risk factors of the pCR rate in gastric cancer patients who underwent NAC. Results PNI (OR:3.026;95％ CI:1.261, 7.260;P = 0.013), differentiation (OR:0.470;95％ CI:0.270, 0.819;P = 0.008), and tumor location (OR:0.341;95％ CI:0.164, 0.708;P = 0.004) were the independent risk factors associated with the pCR rate of the gastric cancer patients who underwent NAC. After PSM, PNI (OR:2.728;95％ CI:1.130, 6.587;P = 0.026) was the independent risk factor associated with the rate of pCR after NAC. Conclusion Gastric cancer patients who underwent NAC with low PNI are less likely to get pCR than those with normal PNI.

OBJECTIVE: To investigate the prognostic value of tumor deposits(TD)in N0 stage gastric cancer. METHODS: A retrospective case-control study was performed on clinicopathological data of 751 N0 stage gastric cancer patients who underwent subsequent R0 gastrectomy from January 2011 to February 2013 at Zhengzhou University Affiliated Tumor Hospital. Patients were divided into TD-negative group (688 cases) and TD-positive group (63 cases). Propensity score matching was used to balance the covariances between the two groups, such as age, gender, differentiation degree, tumor location, T stage, perineural invasion, lymphovascular invasion, extent of resection, tumor size, surgical procedure,and chemotherapy. Matching was performed by the minimal adjacent method of 1:2 pairing. The survival analysis was carried out using Kaplan-Meier method,and differences between the curves were detected by log-rank test. Cox proportional hazard model was used to perform univariate analysis and multivariate analysis. RESULTS: After matching,56 patients were allocated into the TD-positive group and 112 patients into the TD-negative group, and the baseline of clinicopathological data of 2 groups matched well (all P>0.05). The median follow-up time was 55.2 (12.0-83.2) months, and 3 patients were lost to follow-up (died of other diseases). In TD-positive group, 38 patients died of gastric cancer and 1 died of other disease. In TD-negative group, 52 patients died of gastric cancer and 2 died of other diseases. The TD-positive group had lower 5-year survival rate than TD-negative group (31.0% vs. 52.9%,χ²=6.230, P=0.014). Subgroup analysis showed that the 5-year survival rate of T1-2 stage TD-positive patients was significantly lower than that of T1-2 stage TD-negative patients (47.1% vs. 92.6%, χ²=11.433,P<0.001),while the difference between two groups with T3-4 stage (23.8% vs. 40.0%, χ²=2.995,P=0.084)was not significant. In patients receiving chemotherapy, the 5-year survival rate of TD-positive group was significantly lower than that of TD-negative group(34.1% vs. 54.8%, χ²=4.122, P=0.042). Further subgroup analysis showed that patients receiving postoperative chemotherapy of TD-positive group both in T1-2 stage (63.6% vs. 100%, χ²=3.830,P=0.048) and in T3-4 stage (24.2% vs. 48.4%, χ²=4.740,P=0.029) had significantly lower 5-year survival rates than those of TD-negative group. However,T1-2 stage TD-positive patients receiving chemotherapy had significantly higher 5-year survival rate as compared to those without receiving chemotherapy(63.6% vs. 16.7%, χ²=5.474,P=0.019).Univariate analysis revealed T stage (HR=1.829, 95%CI:1.490-2.245, P<0.001),perineural invasion (HR=2.620, 95%CI:1.617-4.246,P<0.001),tumor size (HR=1.646, 95%CI:1.078-2.512, P=0.021),TD(HR=1.691,95%CI:1.112-2.572,P=0.014) were associated with the prognosis of patients with gastric cancer. Multivariate analysis showed TD-positive (HR=2.035, 95%CI:1.325-3.126, P=0.001), later T stage (HR=1.812, 95%CI: 1.419-2.313,P<0.001), perineural invasion (HR=1.782,95%CI:1.058-3.002,P=0.030) were independent risk factors for the prognosis of gastric cancer. CONCLUSIONS TD is an independent risk factor for N0 stage gastric cancer,and may be closely related to T stage. Patients with TD-positive stage T1-2 should receive chemotherapy, but the prognosis of TD-positive patients undergoing adjuvant chemotherapy is poorer as compared to TD-negative patients. Therefore, more individualized treatments should be administrated.
Antineoplastic Agents ; therapeutic use ; Case-Control Studies ; Chemotherapy, Adjuvant ; Gastrectomy ; Humans ; Neoplasm Staging ; Prognosis ; Propensity Score ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; mortality ; pathology ; surgery ; Survival Analysis ; Survival Rate

Objective To investigate the effect of dexmedetomidine on perioperative cell immune function in patients undergoing hepatoma surgery. Methods Sixty patients (40-65 y/o, 50-80 kg body weight, ASA grad-ing I-II) with hepatoma were allocated into two groups each containing 30 patients:control group (group C) and dex-medetomidine group (group D). 15 minutes before anesthesia induction, a loading dose of dexmedetomidine 0.5μg/kg was injected intravenously, followed by infusion at 0.4μg/(kg · h)until the end of operation in group D. The equal volume of normal saline was administered in group C.Blood samples were obtained from jugular vein before induc-tion of anesthesia (T0), the end of operation(T1) and 24 h after the end of surgery (T2) for detections of the levels of T lymphocyte subsets (CD3+, CD4+, CD8+) and NK cells by flow cytometry. CIM+/CD8+ratio was calculated. Serum IL-2 and IL-10 were detected by ELISA methods. Results When compared with the baseline value (T0), the levels of CD3+, CD4+, CD4+/CD8+ratio and NK cells significantly decreased at T1 and T2 in group C, and the levels of CD3+and CD4+also significantly decreased at T1 and T2 in group D (P<0.05). Compared with group C, the levels of CD3+, CD4+, NK cells and IL-2 at T1 and T2 were significantly higher in group D, and level of IL-10 at T1 and T2 were significantly lower in group D (P < 0.05). Conclusion Dexmedetomidine could improve the postoperative suppression of immune function in patients undergoing hepatoma surgery.

Objective To investigate the feasibility of detecting adverse drug event( ADE)using Global Trigger Tool( GTT)in Chinese medical institutions. Methods Discharged patients' records of the Xuanwu Hospital of Capital Medical University from January 1st to December 31st 1013 were collected. After sorting by discharged date,30 cases were selected in a half month period by a random sampling tool of Microsoft Excell1007 software. Unqualified cases were eliminated according to the inclusion criteria( patients aged 18 and over,one time admission in 1013,and hospitalization for more than 1 day)and exclusion criteria( patients in the Department of Obstetrics,Family Planning,Rehabilitation,Oncology,Pediatrics, and day-care ward). The 10 cases were reviewed every half a month in sequence of random sampling using 35 triggers,including laboratory indexes,antidotes,clinical symptoms,and treatment measures,that were identified by GTT recommendation,relevant foreign researches,and self-experience of Xuanwu Hospital of Capital Medical University. All cases were enrolled if the number of cases which met the inclusion criteria was less than 10. The cases in whom triggers could be detected were marked as the cases with positive triggers. The cases with positive triggers-related situations were further reviewed in order to identify or exclude ADE and then the identified ADEs were classified. The positive triggers and ADEs were analyzed by Microsoft Excell1007 software and the positive predictive values of positive triggers were calculated. Results Totally 465 cases were reviewed. Of them,156 were male and 109 female with the mean age of 57(19~91)years. The time of hospital stay was 1 to 37 days with the mean hospital stay of 10 days. Of the 465 patients,in 108 patients(44. 7%)positive triggers could be detected. Of all the 35 triggers,11 triggers(61. 9%)were positive referring to 341 times. There were 18 ADEs identified involving 16 patients and the detectable rate was 3. 4%(16/465). Of the 18 ADEs,13 ADEs had their corresponding triggers containing 8 triggers. The overall positive predictive value of 11 positive triggers was 3. 8%. The 18 ADEs included pneumonia (1 ADEs),liver injury(1 ADEs),chill(1 ADEs),skin rash(1 ADEs),antibiotic-associated diarrhea (1 ADE),headache(1 ADE),dizziness(1 ADE),nausea and vomiting(1 ADE),hypoglycemia (1 ADE),over-sedation(1 ADE),delirium(1 ADE),bleeding(1 ADE),leucopenia(1 ADE),and excitation(1 ADE). There were 14 ADEs of class E and 4 ADEs of class F in the 18 ADEs which referred to 11 drugs including 5 kinds of antibacterial agents, 3 kinds of blood system drugs, 3 kinds of psychotherapeutic agents,1 kinds of cardiovascular drugs,1 kinds of hormone drugs,1 kinds of Chinese patent medicines,1 kind of lipid drug,1 kind of drug acting bone metabolism,1 kind of antipyretic analgesic,and 1 kind of anesthetic. Conclusions GTT could help to early detect the signals of ADEs and provide the reference evidence of preventing drug risk. It is valuable that GTT is popularized and used in Chinese medical institutions.