OBJECTIVE To explore the construction of selection system for drug directory of the county-level medical community based on multi-criteria decision analysis,and provide decision-making basis for the selection of drug directory of medical community.METHODS Taking county-level medical community in Chongqing as an example,Delphi method and analytic hierarchy process were employed to construct the selection system for drug directory of the county-level medical community.Selected drugs were quantitatively scored based on the constructed index system,and the drug directory was selected according to the drug's comprehensive score.The implementation effect of the directory was then evaluated through questionnaire surveys one year after the implementation of the directory.RESULTS The expert authority coefficients of the two rounds of consultation were＞0.8,with Kendall's W values of 0.213 and 0.196,respectively(P＜0.001).Finally,the selection system for drug directory of the medical community was determined to include five evaluation dimensions:safety,effectiveness,economy,accessibility,and innovation,along with eight evaluation indicators.In the drug directory selected according to the above method,the proportions of centrally procured drugs,medical insurance drugs,and essential drugs had all increased compared to before the selection;the comprehensive scores of chemical drugs ranged from 50.25 to 96.31 scores,and the proportion of drugs scoring between 70 and 100 scores had increased from 78.06%before selection to 85.82%.Among them,antiparasitic drugs had the highest comprehensive scores,while drugs for the digestive tract and metabolism were the most numerous.The evaluation scores of each indicator and the comprehensive scores of drugs in the drug directory after the selection process increased significantly than before selection(P＜0.05).CONCLUSIONS The selection system for drug directory of the county-level medical community constructed in this study is scientific,objective and operable.This process facilitates the promotion of standardized and unified management of drugs in the medical community.

It is found that acupuncture can significantly improve the clinical symptoms of rheumatoid arthritis (RA) such as pain and joint stiffness, and improve rheumatoid factor, high-sensitivity CRP, ESR and other clinical indicators. It can inhibit the proliferation of synovial cells, the apoptosis of chondrocytes, and regulate polarization balabce of mononuclear macrophages, T cells, as well as inhibit the inflammatory function of multiple immune cells, in order to improve inflammation state of RA joints. In clinical treatment of RA, bladder meridian, stomach meridian, spleen meridian , and Governor Vessel are mostly selected. Acupoints with the efficacy of warming meridian, dispelling coldness and dredging collaterals were commonly selected such as Zusanli (ST36), Yanglinquan (GB34), Dazhui (GV14), Quchi (LI11). Several researches have proved that combined therapy of acupuncture and medicine is worthy promotion in clinic.

Objective:To explore the efficacy and safety of combining minimally invasive hematoma puncture with urokinase irrigation and continuous drip drainage in patients with spontaneous intracerebral hemorrhage.Methods:A total of 22 patients with spontaneous intracerebral hemorrhage admitted to Department of Functional Neurosurgery, Zhujiang Hospital of Southern Medical University and Department of Neurosurgery of Yuebei People's Hospital from May 2023 to January 2024 were chosen. Using precise localization, a minimally invasive haematoma puncture was used to insert a balloon drainage catheter into the hematoma cord; urokinase irrigation was administered during the procedure, followed by continuous drip drainage postoperatively. A retrospective analysis was performed; their clinical data before and after the procedure were collected; and Glasgow Coma Scale (GCS) score, hematoma residual volume, hematoma evacuation rate and complications were analyzed.Results:In these 22 patients, the residual hematoma volume after intraoperative suction was (20.89±10.74) mL, with a residual rate of (51.86±14.88)%. After the 1 st urokinase injection for continuous drainage, the residual hematoma volume in the 22 patients was (12.72±7.92) mL, with a hematoma evacuation rate of (35.01±30.41)%. After the 2 nd injection, the residual hematoma volume in the 13 patients was (9.48±6.12) mL, with a hematoma evacuation rate of (42.03±20.89)%. After the 3 rd injection, the residual hematoma volume in the 7 patients was (5.84±2.84) mL, with a hematoma evacuation rate of (49.32±11.09)%. After the 4 th injection, the residual hematoma volume in the 3 patients was (3.67±3.79) mL, with a hematoma evacuation rate of (54.44±32.03)%. After the 5 th injection, the residual hematoma volume in the left 1 patient was 5 mL, with a hematoma evacuation rate of 37.50%. Before tube removal, the residual hematoma volume in these 22 patients was (6.73±5.01) mL, with a hematoma evacuation rate of (81.48±13.56)%. During hospitalization, 1 patient experienced postoperative hemorrhage and ultimately died of cardiac arrest; 1 patient developed pulmonary infection after surgery and cured with antibiotics. These patients had GCS scores of 12.23±3.16 at discharge, which was significantly increased than those at admission (9.45±3.19, P<0.05). Conclusion:Minimally invasive hematoma puncture combined with urokinase irrigation and continuous drip drainage is a safe and effective new treatment in spontaneous cerebral hemorrhage.

Objective:To explore the efficacy and safety of combining minimally invasive hematoma puncture with urokinase irrigation and continuous drip drainage in patients with spontaneous intracerebral hemorrhage.Methods:A total of 22 patients with spontaneous intracerebral hemorrhage admitted to Department of Functional Neurosurgery, Zhujiang Hospital of Southern Medical University and Department of Neurosurgery of Yuebei People's Hospital from May 2023 to January 2024 were chosen. Using precise localization, a minimally invasive haematoma puncture was used to insert a balloon drainage catheter into the hematoma cord; urokinase irrigation was administered during the procedure, followed by continuous drip drainage postoperatively. A retrospective analysis was performed; their clinical data before and after the procedure were collected; and Glasgow Coma Scale (GCS) score, hematoma residual volume, hematoma evacuation rate and complications were analyzed.Results:In these 22 patients, the residual hematoma volume after intraoperative suction was (20.89±10.74) mL, with a residual rate of (51.86±14.88)%. After the 1 st urokinase injection for continuous drainage, the residual hematoma volume in the 22 patients was (12.72±7.92) mL, with a hematoma evacuation rate of (35.01±30.41)%. After the 2 nd injection, the residual hematoma volume in the 13 patients was (9.48±6.12) mL, with a hematoma evacuation rate of (42.03±20.89)%. After the 3 rd injection, the residual hematoma volume in the 7 patients was (5.84±2.84) mL, with a hematoma evacuation rate of (49.32±11.09)%. After the 4 th injection, the residual hematoma volume in the 3 patients was (3.67±3.79) mL, with a hematoma evacuation rate of (54.44±32.03)%. After the 5 th injection, the residual hematoma volume in the left 1 patient was 5 mL, with a hematoma evacuation rate of 37.50%. Before tube removal, the residual hematoma volume in these 22 patients was (6.73±5.01) mL, with a hematoma evacuation rate of (81.48±13.56)%. During hospitalization, 1 patient experienced postoperative hemorrhage and ultimately died of cardiac arrest; 1 patient developed pulmonary infection after surgery and cured with antibiotics. These patients had GCS scores of 12.23±3.16 at discharge, which was significantly increased than those at admission (9.45±3.19, P<0.05). Conclusion:Minimally invasive hematoma puncture combined with urokinase irrigation and continuous drip drainage is a safe and effective new treatment in spontaneous cerebral hemorrhage.

Objective: To investigate the therapeutic effects of Tuina (Chinese therapeutic massage) in a knee osteoarthritis (KOA) rat model and its influence on proteins associated with the Wnt/β-catenin signaling pathway. Methods: A total of 32 specific-pathogen-free grade Sprague-Dawley rats were used. Eight rats were randomly selected as the control group (CG). The remaining 24 rats underwent intra-articular injections with 0.2 mL of 4％ papain to prepare the KOA rat models. After the model was established, the 24 rats were randomly and equally assigned to 3 groups, including a model group (MG), a Tuina group (TG), and a positive medicine group (PMG), with 8 rats in each group. The Lequesne score was applied to evaluate the success of model development. After the model was successfully established, the CG did not receive any intervention, and the TG was treated with local, clockwise annular Rou-Kneading around the knee joint with the thumbs. The pressure in the longitudinal direction was 3 N, and the frequency was designed to be 120-140 times/min for 15 min, followed by flexing the joint 10 times. The PMG was intragastrically administered with celecoxib [24 mg/(kg·bw)] every day. These interventions were performed once a day, 6 d per week, for a total of 4 weeks. After treatment, the Lequesne score was applied again to assess the severity of the KOA in the rats; hematoxylin-eosin (HE) staining and a mixture of equal volumes of aqueous solutions of safranin O-fast green were used to stain and observe the cartilage morphology and structure; the modified Mankin score was applied to evaluate the pathology; enzyme-linked immunosorbent assay method was used to quantify the C-telopeptide fragments of type Ⅱ collagen (CTX-Ⅱ) and cartilage oligomeric matrix protein (COMP); Western blotting was then applied to quantify Wnt4, β-catenin, matrix metalloproteinase 13 (MMP-13), and bone morphogenetic protein 2 (BMP-2) protein expression; immunohistochemistry was conducted to determine the percentage of collagen type X (ColX)-positive cells. Results: The Lequesne score of the TG and PMG was both lower than that of the MG (P<0.01); the HE staining, safranin O-fast green stained morphology and structure, and modified Mankin scores of the TG and the PMG were also better than those in the MG (P<0.01). Compared with the CG, the amounts of CTX-Ⅱ and COMP in the serum were significantly increased (P<0.01); the expression of Wnt4, β-catenin, MMP-13, and BMP-2 proteins in the cartilage tissue was significantly increased (P<0.01), and the percentage of ColX-positive chondrocytes was significantly increased (P<0.01) in the MG. In comparison with those in the MG, the amounts of CTX-Ⅱ and COMP were significantly decreased (P<0.01), the expression of Wnt4, β-catenin, MMP-13, and BMP-2 proteins was significantly decreased (P<0.01), and the percentage of ColX-positive chondrocytes was significantly decreased (P<0.01) in the TG and PMG. Compared with the PMG, the contents of CTX-Ⅱ and COMP and the expression of Wnt4, β-catenin, MMP-13, and BMP-2 proteins were decreased (P<0.05 or P<0.01); the percentage of ColX-positive chondrocytes was significantly decreased (P<0.01) in the TG. Conclusion: Tuina can relieve the degeneration of KOA, and the mechanism may be related to the down-regulation of the Wnt/β-catenin signaling pathway, the decrease in MMP-13 and BMP-2 protein expression, the reduction in chondrocyte extracellular matrix degradation, and slowing down the terminal cell differentiation.

BACKGROUND: The presence of fibrosis is a criterion for subtype classification in the newly updated hypersensitivity pneumonitis (HP) guidelines. The present study aimed to summarize differences in clinical characteristics and prognosis of non-fibrotic hypersensitivity pneumonitis (NFHP) and fibrotic hypersensitivity pneumonitis (FHP) and explore factors associated with the presence of fibrosis. METHODS: In this prospective cohort study, patients diagnosed with HP through a multidisciplinary discussion were enrolled. Collected data included demographic and clinical characteristics, laboratory findings, and radiologic and histopathological features. Logistic regression analyses were performed to explore factors related to the presence of fibrosis. RESULTS: A total of 202 patients with HP were enrolled, including 87 (43.1%) NFHP patients and 115 (56.9%) FHP patients. Patients with FHP were older and more frequently presented with dyspnea, crackles, and digital clubbing than patients with NFHP. Serum levels of carcinoembryonic antigen, carbohydrate antigen 125, carbohydrate antigen 153, gastrin-releasing peptide precursor, squamous cell carcinoma antigen, and antigen cytokeratin 21-1, and count of bronchoalveolar lavage (BAL) eosinophils were higher in the FHP group than in the NFHP group. BAL lymphocytosis was present in both groups, but less pronounced in the FHP group. Multivariable regression analyses revealed that older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors for the development of FHP. Twelve patients developed adverse outcomes, with a median survival time of 12.5 months, all of whom had FHP. CONCLUSIONS Older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors associated with the development of FHP. Prognosis of patients with NFHP was better than that of patients with FHP. These results may provide insights into the mechanisms of fibrosis in HP.
Humans ; Bronchoalveolar Lavage Fluid ; Prospective Studies ; Alveolitis, Extrinsic Allergic/diagnosis* ; Fibrosis ; Carbohydrates

Objective:To investigate the clinical value of muscle index changing value during neoadjuvant chemotherapy in predicting the prognosis of gastric cancer after radical gastrec-tomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 362 gastric cancer patients undergoing neoadjuvant chemotherapy combined with radical gastrectomy in 3 medical centers, including 163 cases in Fujian Medical University Union Hospital, 141 cases in the Affiliated Hospital of Qinghai University and 58 cases in St. Mary′s Hospital, from January 2010 to December 2017 were collected. There were 270 males and 92 females, aged from 26 to 79 years, with a median age of 61 years. Of 362 patients, 304 cases in Fujian Medical University Union Hospital and the Affiliated Hospital of Qinghai University were allocated into modeling group and 58 cases in St. Mary′s Hospital were allocated into validation group. Observation indicators: (1) changes of indicators including body composition parameters, tumor markers and stress status indicators in patients in modeling group during neoadjuvant chemotherapy; (2) follow-up and survival of patients; (3) analysis of risk factor affecting prognosis of patients in modeling group; (4) construc-tion and comparison of prognostic prediction models; (5) evaluation of prognostic prediction models. Follow-up was conducted using outpatient examination, telephone interview and mail communication to detect postoperative survival of patients up to April 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Univariate and multivariate analysis were performed using the COX proportional hazard model. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-rank test was used for survival analysis. Results:(1) Changes of indicators including body composition parameters, tumor markers and stress status indicators in patients in modeling group during neoadjuvant chemotherapy: the subcutaneous adipose index, visceral adipose index, muscle index, carcinoem-bryonic antigen, CA19-9, body mass index, prognostic nutritional index and modified systemic inflammation score of 304 gastric cancer patients in the modeling group before neoadjuvant chemotherapy were 31.2 cm 2/m 2(range, 0.6?96.0 cm 2/m 2), 25.1 cm 2/m 2(range, 0.1?86.3 cm 2/m 2), 47.1 cm 2/m 2(range, 27.6?76.6 cm 2/m 2), 43.2 μg/L(range, 0.2?1 000.0 μg/L), 108.7(range, 0.6? 1 000.0)U/mL, 21.9 kg/m 2(range, 15.6?29.7 kg/m 2), 46.8(range, 28.6?69.0), 1.0±0.8, respectively. The above indicators of 304 gastric cancer patients in the modeling group before radical gastrec-tomy were 32.5 cm 2/m 2(range, 5.1?112.0 cm 2/m 2), 25.4 cm 2/m 2(range, 0.2?89.0 cm 2/m 2), 47.0 cm 2/m 2(range, 16.8?67.0 cm 2/m 2), 17.0 μg/L(range, 0.2?1 000.0 μg/L), 43.9 U/mL(range, 0.6?1 000.0 U/mL), 21.6 kg/m 2(range, 31.1?29.0 kg/m 2), 47.7(range, 30.0?84.0), 1.0±0.8, respectively. The changing value of above indicators of 304 gastric cancer patients in the modeling group during neoadjuvant chemotherapy were 1.4 cm 2/m 2(range, ?31.0?35.1 cm 2/m 2), 0.2 cm 2/m 2(range, ?23.5?32.6 cm 2/m 2), ?0.1 cm 2/m 2(range, ?18.2?15.9 cm 2/m 2), ?26.2 μg/L(range, ?933.5?89.9 μg/L), ?64.9 U/mL(range, ?992.1?178.6 U/mL), ?0.3 kg/m 2(range, ?9.7?7.1 kg/m 2), 0.9(range, ?27.1?38.2), 0.0±0.8, respec-tively. (2) Follow-up and survival of patients: 284 of 304 patients in the modeling group were followed up for 3 to 130 months, with a median follow-up time of 36 months. During follow-up, 130 cases died of tumor recurrence and metastasis and 9 cases died of non-tumor causes. The 5-year overall survival rate was 54.6%. Fifty-two of 58 patients in the validation group were followed up for 2 to 91 months, with a median follow-up time of 29 months. During follow-up, 21 cases died with the 5-year overall survival rate of 63.8%. (3) Analysis of risk factor affecting prognosis of patients in modeling group: results of univariate analysis showed that the postoperative pathological type and postoperative pathological staging were related factors affecting 5-year overall survival rate [ hazard ratio=1.685, 2.619, 95% confidence interval(CI): 1.139?2.493, 1.941?3.533, P<0.05] and 5-year progression free rate survival of 304 gastric cancer patients in the modeling group after radical gastrectomy ( hazard ratio=1.468, 2.577, 95% CI: 1.000?2.154, 1.919?3.461, P<0.05). Results of multivariate analysis showed that the postoperative pathological type and postoperative pathological staging were independent influencing factors for 5-year overall survival rate of 304 gastric cancer patients in the modeling group after radical gastrectomy ( hazard ratio=1.508, 2.287, 95% CI: 1.013?2.245, 1.691?3.093, P<0.05) and the postoperative patholo-gical staging was an independent influencing factor for 5-year progression free survival rate of 304 gastric cancer patients in the modeling group after radical gastrectomy ( hazard ratio= 2.317,95% CI: 1.719?3.123, P<0.05). (4) Construction and comparison of prognostic prediction models: the area under curve (AUC) of prognostic prediction model of subcutaneous adipose index changing value, visceral adipose index changing value, carcinoembryonic antigen changing value, CA19-9 changing value, body mass index changing value, prognostic nutritional index changing value, modified systemic inflammation score changing value for 304 gastric cancer patients in the modeling group were 0.549(95% CI: 0.504?0.593), 0.501(95% CI: 0.456?0.546), 0.566(95% CI: 0.521?0.610), 0.519(95% CI: 0.474?0.563), 0.588(95% CI: 0.545?0.632), 0.553(95% CI: 0.509?0.597), 0.539(95% CI: 0.495?0.584). The AUC of prognostic prediction model of muscle index changing value was 0.661(95% CI: 0.623?0.705) with significant differences to the AUC of prognostic predic-tion model of subcutaneous adipose index changing value, visceral adipose index changing value, carcinoembryonic antigen changing value, CA19-9 changing value, body mass index changing value, prognostic nutritional index changing value, modified systemic inflammation score changing value, respectively ( Z=3.960, 5.326, 3.353, 4.786, 2.455, 3.448, 3.987, P<0.05). The optimum cut-off value was 0.7 cm 2/m 2 for prognostic prediction model of muscle index changing. Kaplan-Meier survival curve showed there were significant differences of overall survival and progression free survival for gastric cancer patients with subcutaneous adipose index changing value <0.7 cm 2/m 2 and ≥0.7 cm 2/m 2 in the modeling group ( χ2 =27.510, 21.830, P<0.05). The nomogram prognostic prediction model was cons-tructed based on 3 prognostic indicators including muscle index change value combined with postoperative pathological type and postoperative pathological staging and the AUC of nomogram prognostic prediction model were 0.762(95% CI: 0.708?0.815) and 0.788(95% CI: 0.661?0.885) for the modeling group and the validation group, respectively. The AUC of postoperative pathological staging prognostic prediction model were 0.706(95% CI: 0.648?0.765) and 0.727(95% CI: 0.594?0.835)for the modeling group and the validation group, respectively. There were significant differences of the AUC between the nomogram prognostic prediction model of muscle index change value combined with postoperative pathological type and postoperative pathological staging and the postoperative pathological staging prognostic prediction model in the modeling group and the validation group, respectively ( Z=3.522, 1.830, P<0.05). (5) Evaluation of prognostic prediction models: the nomogram prognostic prediction model of muscle index change value combined with postoperative pathological type and postoperative pathological staging showed that patients with score of 0-6 were classified in the low risk group, patients with score of >6 and ≤10 were classified in the moderate-low risk group, patients with score of >10 and ≤13 were classified in the moderate-high risk group and patients with score of >13 were classified in the high risk group. Kaplan-Meier survival curve showed there were significant differences of the overall survival between the low risk group, moderate-low risk group, moderate-high risk group and high risk group patients in the modeling group and the validation group, respectively ( χ2 =75.276, 14.989, P<0.05). Results of decision making curve showed the nomogram prognostic prediction model of muscle index change value combined with postoperative pathological type and postoperative pathological staging had better clinical utility than the postoperative pathological staging prognostic prediction model in the modeling group and the validation group. Conclusions:The muscle index changing value of gastric cancer patient during neoadjuvant chemotherapy can be used as a prognostic indicator for gastric cancer patient prognosis after radical gastrectomy. The risk score of the nomogram prognostic prediction model of muscle index change value combined with postoperative pathological type and postoperative pathological staging can be used to evaluate the survival and prognosis of gastric cancer patients after radical gastrectomy.

Objective:To conduct Meta-analysis of the effectiveness of improved activity mode in prevention of peripherally inserted central catheter (PICC) related thrombosis in tumor patients.Methods:PubMed, The Cochrane Library, CNKI, Wanfang Database and VIP database were conducted computer retrieval of studies on improved activity mode and PICC related thrombosis in tumor patients from January 1, 2010 to December 31, 2019. A total of two researchers independently screened literature, extracted data and evaluated the quality of literature. The RevMan 5.3 software was used for Meta-analysis of the included studies.Results:A total of 7 randomized controlled trials (RCT) were included in this study. Meta-analysis results showed that compared with the conventional catheterization side upper limb exercise group, the incidence of catheter-related venous thrombosis in tumor patients in the improved activity mode group was reduced ( OR=0.22, 95% CI=0.13-0.38, P<0.01) , and the maximum blood flow velocity of the axillary vein was increased ( MD=1.03, 95% CI=0.64-1.42, P<0.01) . Conclusions:Improved activities on the limb of catheterization can effectively accelerate the blood flow velocity of the axillary vein after PICC catheterization in tumor patients and reduce the occurrence of catheter-related venous thrombosis.

One major strategy to generate genetically modified mouse models is gene targeting in mouse embryonic stem (ES) cells, which is used to produce gene-targeted mice for wide applications in biomedicine. However, a major bottleneck in this approach is that the robustness of germline transmission of gene-targeted ES cells can be significantly reduced by their genetic and epigenetic instability after long-term culturing, which impairs the efficiency and robustness of mouse model generation. Recently, we have established a new type of pluripotent cells termed extended pluripotent stem (EPS) cells, which have superior developmental potency and robust germline competence compared to conventional mouse ES cells. In this study, we demonstrate that mouse EPS cells well maintain developmental potency and genetic stability after long-term passage. Based on gene targeting in mouse EPS cells, we established a new approach to directly and rapidly generate gene-targeted mouse models through tetraploid complementation, which could be accomplished in approximately 2 months. Importantly, using this approach, we successfully constructed mouse models in which the human interleukin 3 (IL3) or interleukin 6 (IL6) gene was knocked into its corresponding locus in the mouse genome. Our study demonstrates the feasibility of using mouse EPS cells to rapidly generate mouse models by gene targeting, which have great application potential in biomedical research.